The Autopsy

How could two children die within ten months of each other? At first Deanne didn’t suspect Ellen of having committed murder. What perplexed Deanne was the sheer improbability of it. She had nothing to go on, but it was gnawing at her insides.

When she went to work the next morning, she called a friend. The more they talked about the circumstances of Steven’s death, the more uncomfortable they became.

Neither of them could believe that Ellen had anything to do with it, but they also couldn’t justify what had happened. David’s supposed crib death at twenty-eight months still seemed wrong somehow. Then, they asked each other, how unlikely is it that Ellen just happened to be home from work when Steven died, and that Stacy and Steven happened to be asleep when David had died? Deanne still hadn’t forgotten how strange Ellen was about taking David off the life support: It was as if she couldn’t wait for his life to end. Deanne had let it go at the time as an odd reaction in a crisis, but now she saw Ellen’s coldness in a new light.

“You know, these stories don’t match,” Deanne said.

“I know.”

“Ellen told our receptionist Steven died in the middle of the night.”

“I know.”

“But it was in the middle of the day.”

The phone line was awfully silent for a moment or two before Deanne spoke again.

“I’ve got to talk to somebody about this.”

“I’ve been thinking the same thing.”

Neither of them wanted to accuse Ellen of murdering her own children, but too many facts pointed that way to be ignored. Both women had some friends who were policemen in the city, and Deanne’s friend knew one well enough to call and just ask about the likelihood of something like this happening. That’s all they wanted to know, and that’s how her friend put it when she made the call the next morning to Sergeant Daniel Duffy, a supervisor in the gambling section.

“I would really like to know how two children can die in the same family ten months apart, and there’s no investigation.”

Both of them believed that if the police were already looking into this, Ellen would have told Deanne about it.

“I just don’t understand it. What is the chance of that?”

“Is this hypothetical, or do you know something?” Sergeant Duffy wanted to know.

“No, I don’t know anything. And, you know, I don’t want to accuse a mother of doing something to those children. But it just doesn’t feel right.”

Sergeant Duffy got the name and address, and the information about the two boys’ deaths, as Ellen had explained it, and then he was told about a third child, a girl.

“Okay,” Sergeant Duffy said. “I’ll call you back as soon as I know anything.” After he hung up, he pulled his notes together, then rang Homicide. The caller, he said, wanted to remain anonymous, but the information, he would discover, was red-hot. The medical examiner had already started the autopsy on Steven Michael Boehm, and he wasn’t making much progress understanding what had killed the boy.

Dr. Michael Graham was a boyish-looking man whose clinical style didn’t overwhelm a friendly smile. He had been notified by the emergency room staff at Cardinal Glennon that the child had been home watching television on Monday morning when his mother found him unresponsive. Now it was Tuesday morning. The time was eight o’clock, and the dead boy had been brought to Dr. Graham’s pathology room for an autopsy. He was disturbed to receive the body of a boy who had suddenly died without explanation, but he had handled such cases before.

In fact, Dr. Graham had performed an autopsy on David Boehm less than a year earlier. In that case, he recalled, the mother had given a story that corresponded with the sudden death of a child. There was a viral illness of some kind, and Dr. Graham had seen sudden deaths associated with that kind of preexisting condition.

In David’s case there had been no injuries, and nothing really suspicious about the death, except that there was no medical explanation for it. As he looked down at Steven’s body, he remembered signing the record for David: sudden death of undetermined etiology following apparent viral syndrome. In other words, it was a natural death.

With Steven, the story was essentially the same. There were no injuries to the body. Just as he had in David’s case, Dr. Graham would take numerous samples of Steven’s tissues, blood, bile, and urine for lab analysis. He would have to await those results. At this point he was not comfortable saying that this too was a natural death, even though there was no evidence to suggest that anything was done intentionally to harm this boy.

This was the second, nearly identical death of a young male child in the same household within a year’s period, and Dr. Graham’s level of suspicion was raised severalfold.

When Steven had arrived at Cardinal Glennon, he had been in full cardiopulmonary arrest, but was still alive. This meant that he had had the typical, extensive blood sampling that is done. What was discouraging was that the analysis of those samples only excluded possibilities. Dr. Graham had found no clues as to why Steven had died.

With metabolic screening, he would be able to rule out any errors in metabolism that might be congenital. With other tests he would eliminate poisoning. He could exclude illness and rule out accidental death. The likelihood of two such accidents occurring in the same way, with the same exact result, argued against that conclusion, which led him to the supposition: How can you kill children without leaving any evidence?

It was possible with drugs, but all of the toxicology tests Dr. Graham conducted were negative for drugs. He even included therapeutic drugs, because Ellen was on some mild medication. Another way was electrocution, but there were no real indications of such a cause of death. Children could also be drowned. But this was an unlikely scenario, because to attempt to conceal an intentional drowning, the parent would have had to have dried the child’s hair and redressed them in fresh clothes. It didn’t seem to be the case here.

Death by asphyxia was high on Dr. Graham’s list of possibilities. It was difficult to strangle a child without leaving a mark about the neck area, but if someone either lay on top of a child or put something over the face, called mechanical asphyxia, there might not be telltale marks.

His findings left him with one course of action. The cause of death would be withheld pending the receipt of more laboratory tests. At least for now, he would have to say that the cause of death was undetermined, based on the completed autopsy and on microscopic and toxicological examinations.

In his ten years as a medical examiner, this was an extraordinary case: multiple deaths in the same family at the hands of a mother without leaving a mark on her sons’ bodies. Based on what he could surmise, he favored the mechanical asphyxia theory. Given the circumstances, it would be a double homicide, he knew. He also realized, though, especially considering the total absence of any physical evidence, that this was not the kind of accusation lightly made against a mother.

Facts had to be gathered. Detectives had to enter the case. And, Dr. Graham decided, this was one for Joe.