The conference room at the San Francisco Office of Chief Medical Examiner has a table and some chairs, a fancy electronic whiteboard for presentations, four walls, and a door. It has no windows. When I arrived for work on Thursday morning, I found that it had no forced air ventilation, either. Worse, the seasonal Diablo winds had started blowing during the night, bringing hot air and frayed nerves. The OCME conference room felt like a furnace and smelled like a gym.
My colleague, Assistant Medical Examiner Dr. Theodore Nguyen, was running the morning meeting.
“What is it this time?” Sunshine Ted (as I referred to him, in secret, to Anup) wanted to know. He wanted me, as deputy chief, to tell him.
“I don’t know what it is this time, Ted. I’ve called facilities maintenance. Let’s make this meeting quick and get out of here, okay?”
“Out of here, and then where? There’s no A/C in my office. Is it working in the autopsy suite?”
“No.”
Groans around the room, even from the half-dozen medical students on rotation from UCSF.
The break-in period for our shiny new morgue had been hard going. This facility, after a decade in the planning and millions of taxpayer dollars in the building, turned out to have doors that got jammed in their frames and double-glazed windows that cultivated black mold. The lighting fixtures lit things we didn’t want lit and left the things we needed to see in shadow. The wiring couldn’t handle the load from our collection of high-wattage diagnostic equipment, especially the shockingly expensive full-body X-ray machine. That thing filled half a room, and included a conveyor belt that fed the body through the sensor array. One of the students had observed that it looked just like a quick-bake machine from the fast food joint where he worked; and so it was dubbed the Quiznos 5000. The Quiznos 5000 sucked so much current that it would routinely trip the circuit breaker for the entire facility. So we had mostly stopped using the Quiznos 5000.
The newest crisis in our physical plant involved the sudden and complete loss of all climate control systems for an hour or two at a time, or sometimes more. The last guy from facilities maintenance had referred to it as “HVAC gremlins,” and said he’d get right on it. It seemed he had made it worse.
“Three hours!” Sunshine Ted said. “Right, Cam?”
Cameron nodded. “It went down in the Operations Center a little before five this morning.”
“Did you try to get it back on?” I asked.
Cam looked at me like I had sprouted a new head. “How? Do you know where the HVAC lives? ’Cause I don’t. Air comes through the vents in the Ops Shop, or it doesn’t. Believe me, Doc, if there was a box to kick-start somewhere, I’d give it a try.”
Donna giggled. Cam nudged her and grinned.
“Okay, okay,” I said, and wiped sweat from my brow. “I’ll get on the building people again.”
“Dr. Howe has already ripped them a new one,” Donna said.
“Good. So what do we got on the case list today?”
Morning meeting is the only time during the day when all the morgue principals—doctors, investigators, and autopsy technicians—get together. We discuss and assign the day’s new death investigations. For more than a year we had been running a shorthanded shop with only two forensic pathologists instead of three. Hell, optimally we’d have four. But we had two: me and Ted Nguyen.
Cameron made short work of rattling off the details about the Leopold Haring scene, and just as quickly presented the day’s four other new cases. An elderly woman had suffered a fatal fall in a nursing home. An inpatient with schizophrenia died in the General Hospital’s psych ward. A sixty-seven-year-old man with a history of heart disease collapsed while waiting for a seat at a popular restaurant in Hayes Valley. And, finally, a twentysomething woman was found cold and stiff on a girlfriend’s couch after partying all night.
Donna sighed. “Wild Wednesday nights. I remember those.”
“All right,” said Ted Nguyen, “Jessie, you’ve already got yesterday’s holdover from the construction site, so you take the geriatric fall and the OD on the couch, and I’ll handle the other two.” He shuffled the folders and slid mine over the tabletop.
“Let’s get to work.”
The autopsy suite was even more oppressive than the conference room. We perform our work under surgical lights. They’re hot. Worse, before we start cutting into dead bodies, we first have to suit up in several layers of personal protective equipment, including a Tyvek gown, an N95 respirator mask, a bouffant cap, and three layers of gloves. I felt the sweat trickling down my backbone before I’d left the women’s locker room.
Someone with no sense of irony had put up a bunch of Halloween decorations in the morgue. They were childishly incongruous ones, to boot: smiling Frankensteins and goofy Draculas, waltzing ghosts with Day-Glo imprecations like Beware of Zombies, and Life’s a Witch. The medical students were clustered around my autopsy table, which didn’t make the airflow problem any better. Yarina Marchenko barked at them to clear a path, then elbowed her way through before they had a chance to.
“Dzień dobry, proszę Pani,” I said.
“Dobroho ranku, Likarya,” Yarina replied. It was our good morning ritual. Yarina was our one and only morgue technician. We really should have had three, at a minimum two, but we had one. Yarina was a diminutive woman of late middle age, trained as a physician in her native Ukraine. We’d worked together for nearly a year and a half, and had learned to accommodate one another. Mostly.
Yarina and I made quick work of the first two cases. The nursing home death was a simple external examination with chart review of a seventy-three-year-old had who fallen and broken a hip, dying of pneumonia and heart failure a week later. Cause: complications of hip fracture. Manner: accident. Next was the midweek party guest who woke up dead on her friend’s couch. I shined a flashlight up her nose and spotted a hole eroded in the nasal septum. You get that from snorting coke. When I opened her up, I found an alcoholic fatty liver. Drug overdose, probably combined cocaine and alcohol. Toxicology results would tell us for sure, though they would take weeks to come back. In the meantime, cause and manner pending.
We were done with those two cases in less than an hour—though it felt like three. I had to change my bouffant cap after brow sweat leached into the thing and soaked it to dripping. The air in the morgue was getting swampy, and it was a labor to breathe through the N95 mask. Yarina wheeled in the dusty nylon pouch that contained Leopold Haring’s remains. I warned the students that this was a pretty gnarly one, then unzipped it. There were some gasps, but no one fainted.
I went through the external examination carefully. The decedent was wearing a dark blue business suit and white shirt, all of fine manufacture. His wallet was in the left hip pocket where we’d replaced it after checking ID at the scene. The other held the keys to a Lexus and a vial of eye drops. His suit jacket’s flap pockets had a small notebook full of scribbled figures and a handheld laser ruler similar to the ones the CSI crew uses to measure distance. An inside breast pocket was zippered closed. It held something bulky. I pulled it out.
“Rocks,” one of the students observed.
“Rocks,” I agreed, but then examined more closely. It was a lump of aggregate, pebbles held together in a dull yellow matrix that looked and felt like a cross between cement and dried glue. There seemed to be tiny silvery hairs mixed in there, too. The lump was lighter than its size suggested it should be.
“What is this?” I asked.
“It’s a rock, Dr. Teska,” a student said. “Construction sites have lots of them.”
“Yeah, but this one is weird looking. And how come it was zipped up inside his jacket?”
The medical students stared back at me like a small herd of sweaty cattle.
“It didn’t land there by accident,” I said, and logged it as rocky aggregate building material in the man’s personal property, along with his wedding band and class ring, and the other things that had come out of his pockets.
Now that I had the body under the hot lights of the autopsy suite, I could see that his pants were torn from the butt all the way down both legs, with the hems really ripped up. All the damage was to the rear; the front was pristine. The skin of the lower calves and Achilles’ heels on both legs showed significant abrasions, tan in color and nonhemorrhagic.
I asked the students what that meant. Two answered in unison: “Postmortem injury.”
“That’s right. Now look at the damage to his clothes. What does it tell you?”
Nervous silence.
“What’s the direction of force appear to be?”
“Um,” a student said, “down?”
“Exactly! Along the length of the limbs. Look closely. There’s more tissue damage at the bottom of each wound than at the top. These defects were caused by friction force applied in a superior to inferior direction, without lateral vector, while clothed, on a man who was already dead. Hand me the camera.”
I took the pictures myself, since Yarina had fired up the bone saw and was busy cutting a halo around the skull on Ted’s psych ward case. Leopold Haring’s limbs were limp, past rigor mortis, which meant decomposition was advancing. It was going to happen fast in the jungle heat of the autopsy suite. It worried me.
“Let’s get this evisceration going, people,” I said to the students, and collected my lucky pink #22 scalpel from among my tools.
“Hello...?” said an unfamiliar voice. It belonged to a man. He was standing inside the secure door from reception. He was dressed in street clothes. He wasn’t wearing a mask or gloves, or any other PPEs.
“Stop right there,” I ordered. “How did you get in here?”
“I have a key card,” the barefaced man said, brandishing it.
The sweltering autopsy suite stank of cadavers. Yarina was sawing into a human head, making a hellish din and throwing up flecks of skull. Ted Nguyen used a long knife to take a slice out of a fresh human heart. I was standing over a man in a sharp suit who had a grimy pile of hamburg in place of his head. It was clear from his expression that this wasn’t at all a place the man in the doorway had been expecting to end up.
I shouted over the bone saw. “Where’d you get a key card?”
“Facilities maintenance. I’ve been sent to help with the HVAC system...”
Yarina finished, and the saw racket wound down. “Good!” she said. “You must wear mask. Gloves, paper booties. Go back now. Hurry fast, we need air!”
She pointed the bone saw toward the door. The bone saw is a 250-watt tool that calls to mind a mammoth hand blender. The serrated blade sticking off its business end was dripping blood. The man swiveled and went through the door, fast.
“Hope he comes back,” Sunshine Ted said.
I asked one of the male medical students to chase after the guy and get him into minimum PPEs from the locker room. The two of them came back, suited up, inside five minutes—and the man was carrying a stepladder and toolbox. The other medical students broke into a spontaneous, sweaty cheer. The man’s eyes crinkled into a smile over the N95 mask.
“I’ll hand it to you, Mr. HVAC,” I said, “you’re dedicated.”
“Denis. Denis Monaghan,” he said automatically. He had an Irish brogue.
“I’m Deputy Chief Jessie Teska. What are you doing in our autopsy suite, Denis?”
“I’ve isolated the problem with the climate control system. It’s a unit in the ceiling here.”
“Is there another way to get at it?”
“The only access panel is in here, Deputy Chief Teska.”
“Call me Jessie. That strikes me as an unfortunate design choice, if you’ll forgive my saying so, Denis.”
“I couldn’t agree more, Jessie. I’m only here to fix someone else’s mistakes, and I’m afraid there’s no other way to do it.”
“And I’m afraid I can’t let you stay in here while we’re doing autopsies. Occupational Safety and Health would have a conniption and levy a nasty fine.”
“Fair enough,” Denis Monaghan said. “But this is a negative-pressure space. With the system down, no air can get in at all. It’s brutal hot in here now, and if I don’t get that unit in your ceiling working, it’ll be desperate.”
“It’s desperate already,” Ted muttered. He and Yarina were pulling out the schizophrenic’s brain.
“No,” I said. “I can’t let you do it.”
“Right,” said Monaghan. “Well, then.” He waved the key card he’d used to get into the autopsy suite. “I’ve been sent here to do an urgent job, and I intend to do it. May I ask to speak to your supervisor, please?”
I was just about to tell Denis Monaghan that I, as deputy chief, was the final authority in this matter, when another man’s voice boomed across the autopsy suite.
“Good God...! This is horrible!”
Chief Medical Examiner Dr. James Howe had arrived for morning rounds.
“This is insane!” he hollered. Howe wore, as he wore every morning, a surgical apron over his staid business suit. Sweat beaded on his bald head. He had young eyes that belied his age, and knotted hands that exaggerated it.
Howe locked on to Denis Monaghan. “Who is this?”
Monaghan introduced himself and, before I could beat him to it, told Dr. Howe about the broken HVAC unit.
“Well, what are you waiting for?” Howe said. “Fix it!”
“I’d like to,” Monaghan said, and tipped his head sidelong toward me. “But I’m being told I’m not allowed to work in here so long as your crew are using the place...”
“Why the hell not?”
I cut in. “OSHA rules, Dr. Howe.”
“OSHA?” Howe said. “To hell with OSHA! We can’t work like this.”
“But we can’t—”
“We can if it’s an emergency,” Howe said. “And it’s an emergency if I declare it is. This goddamn well fits the bill!”
He pointed a bony finger at Monaghan. “You. Get to work.”
“Yes, sir,” said Monaghan. He lifted his stepladder and carried it across the autopsy suite. He had to skirt my table. As I made room for him to pass, he thanked me, and—I shit you not—he winked.
Monaghan set the ladder and climbed it, and pushed a panel in the drop ceiling. His top half disappeared, and shortly there came a sound of discouragement and the clank of tools.
“The show must go on!” Howe declared. Then he told Yarina to come get him in his office once the air-conditioning was turned back on. He’d delay morning rounds until then.
And he left.
“Okay then,” I said. “Let’s keep at it.”
I turned my attention back to Leopold Haring. He was definitely starting to stink. The students looked miserable, though one, a woman with gorgeous, curly black hair leaking out of her bouffant cap, seemed eager and engaged. I asked her to help me peel the clothing off the corpse, stopping to take photos when I came across anything interesting. The pattern of bleeding, for one thing. That was very interesting.
“There’s a lot of hemorrhage here on the posterior side,” I pointed out to the students. We peeled off the dead man’s jacket, dress shirt, T-shirt. All three layers were soaked through with a round bloodstain, about six inches in diameter. I took pictures, then washed the blood off the skin of his upper back. Sure enough, left behind when the blood drained away, I saw a hole.
“How do you like that,” I said.
“It’s a gunshot wound!” the student with the great hair said.
The hole was oblong, with ratty edges. I pressed them together with my gloved fingers, and showed the students that I was not able to reapproximate the wound margins. “Punched-in hole characteristic of a bullet entrance wound.”
“Where’s the exit?”
“When I cut into him, I’m going to trace the wound track underneath that hole. Then we’ll find out.”
“This is great!”
I asked her name.
“Patty Alvarez.”
“Take a close look at the clothing, will you, Miss Alvarez? Anything we ought to document?”
She fingered the bloody cloth. “There’s a hole here, too. Right in the middle of the bloodstain, in all three layers.”
“Let’s get pictures.”
“Hold on...” said another student, one who had impressed me as slow on the uptake. “This is a shooting?”
“This is a wound with vital reaction hemorrhage that might be from a bullet.”
“I thought you said somebody dropped pipes on his head.”
“There was a load of pipe lying on his head when we arrived at the scene. What that means, I don’t know yet.”
“It means somebody was trying to make a shooting look like an accident,” the thick student said.
“We don’t draw conclusions until we’ve gathered all the data. For starters, now that we have the body stripped and photographed, let’s hose it off and do an inventory of injuries. Maybe we’ll find another wound that corresponds with this one.”
We started with the head and neck. Once I had rinsed away the dirt and arranged the pieces of scalp in approximately the right places...it was still a grotesque mess, even by my standards. Most of the face was a tan-colored pulp—postmortem injury, just like the abrasions on the legs and heels. The nose, though, was different. It was swollen and pinkish, like a recent injury had been starting to heal.
I palpated it. Could be broken, a little hard to tell with all the other damage to the facial bones. “Dried blood in the nostrils, and inside the lips,” I noted aloud, then sliced down with my scalpel and cut off a chunk of the nose. This horrified several of my students. I explained that I don’t like to deface bodies, but that I needed to get a tissue sample and examine it under a microscope.
I looked over the whole body again. The injury to the back had definitely happened while Leopold Haring’s heart was still beating. Between the lack of blood at the scene and the drag marks and damage to his legs, it was possible he died from that wound somewhere else, and was then staged under the pipes to make the death look like a work accident.
“Time to get cutting,” I announced.
I made the Y-incision from the shoulders to the sternum, then straight down to the pubis, opening the torso. His clavicles were shattered, the sternum snapped in half, and his uppermost ribs were in pieces. All these bony injuries were dry of blood.
I heaved the tree lopper tool I use for snapping ribs and went to work on the ones below the area of injury. It’s hard under normal conditions to cut open a full-grown man’s rib cage, and it became an athletic feat in the sweltering heat of the unventilated morgue. Yarina came over to assist, and I was grateful to set her to the painstaking task of peeling the scalp off the smashed skull bones. Those, too, were minimally hemorrhagic.
“Well, this is for sure,” I told the students. “He was already dead when his head got smished.”
“Smished?” said Patty Alvarez.
“Write that down.”
I lifted out the front of the rib cage. Immediately underneath it was a lot of blood.
“Hand me that ladle and a measuring cup.” Someone did, and I scooped it out. It measured a liter and a half, all from the left side of the chest cavity. The left lung had a big honking hole in it. I cut into it with my scalpel and found a hemorrhagic track going clear through the lower left lobe, and then into the muscles between the fifth and sixth ribs. The wounds all lined up with the hole on Leopold Haring’s back, and his bloody clothing.
“Pictures, Yarina,” I said.
“What’s with the heart?” said the dense student.
The pericardial sac was distended and rigid. I cut it open and collected 300 ml of bright blood. I removed the heart, turned it around in my hand, and immediately found the source: a ragged defect in the thick muscle of the posterior left ventricular wall.
“Well, we’ve found the end of that wound track,” I said. “Let’s see what’s inside.”
I brought the heart to the foot of the autopsy table and the students crowded around. I dissected it.
No bullet.
“Ted!” I crowed, genuinely excited, “I think I’ve got a bullet embolus here!”
“Good for you,” Nguyen muttered.
“Anyone know what that is?” I asked the students. They didn’t. “If this is a gunshot wound, and if the bullet stopped here in the left ventricle without getting lodged in the muscle tissue, then it’s possible that with the next heartbeat it got pumped into the aorta.” I pushed a finger into the aortic valve to show them how easy that would be. “From there the slug might have surfed the pressurized blood stream through smaller and smaller arteries until it got stuck. That’s a bullet embolus. They’re exceptionally rare!”
“How are you going to find it?” a student asked.
“Good question! By X-ray for sure, after we finish cutting, but that might not be necessary. I might come across the darned thing in gross anatomy. Sometimes they end up lodged in the liver. What a great case!”
I plugged up the scupper pipe in the autopsy table so that no slugs or fragments could disappear down the drain, and filtered the blood I had collected. No bullet. I continued the autopsy, cutting into each of Haring’s other internal organs. In the end, the only place I found any bleeding was from the wound that had skewered his left lung and punctured his heart. That was the cause of death.
Given the effort someone had apparently put into covering up that event, the manner of death was definitely not accident. Haring was a homicide.
After spending nearly an hour taking the man’s entire body apart, I had failed to find a bullet to match the penetrating wound. That meant I had to X-ray the body. Leopold Haring’s lungs, heart, liver, intestines, and the rest of his eviscerated organs lay in a glistening heap at the foot of the autopsy table. I scooped them into a biohazard bag. Then Yarina and I shifted the corpse and the bag back onto a gurney and rolled it—with great care—across the morgue. There was a man perched on a stepladder between my autopsy table and the radiology room, and I didn’t want to sideswipe him. I shuddered to imagine the OSHA report on that.
“Hey, Mr. HVAC!” I yelled. I’d forgotten his name.
“Denis. Call me Denis.” His legs were on the ladder, the rest of him still in the ceiling.
“Yeah, Denis. How’s it going up there?”
“Just brilliant.” He made some clanking noises, presumably to demonstrate the work in progress.
“We can’t take much more of this, Denis. If you can’t get it fixed soon, I’m going to have to shut this place down.”
“Doing me best up here,” he said from the ceiling as I eased the gurney past his ladder.
Yarina and I sweated through the job of feeding the body through the Quiznos 5000 X-ray rig, then I scanned and zoomed around the image on the computer monitor, looking for foreign objects.
Still no bullet. Nothing metal in the radiograms at all.
“It’s not a bullet embolism?” said the dense student.
“No.”
“So where’d the bullet go?”
“Maybe it was never there.”
“Huh...?”
Before I could explain, there was a whooshing sound and a breeze came through the vents.
“Hallelujah!” somebody yelped, and the whole morgue, except for Sunshine Ted, broke into muffled, nitrile-gloved applause.
Denis Monaghan descended from his stepladder. He’d let the mask fall off his face while he worked up there. It was a happy face, and a sweaty one.
“I’m not quite done, but it should stay on for now, so you don’t have to quit.” His smile was replaced by a pious earnestness. “I admire the work you’re doing here, all of ye.”
Ye? I wondered if Denis Monaghan was putting us on. The map of Ireland on his face, as I’d heard said of some of the guys I grew up with in Boston. Monaghan fit the bill, with a short nose and bulb chin, dimples, small gray eyes. He was handsome, in an elfin sort of way.
“Put that mask back on, Denis,” I said. “And, thanks.”
Yarina phoned Dr. Howe to give him the good news, and the chief arrived right away. He joined us in the radiology room and stood over the naked shreds of Leopold Haring while I presented my autopsy findings.
“So,” he said, after I’d finished, “if there’s no bullet and no exit, what do we conclude?”
“This isn’t a gunshot wound,” I said.
The thick student muttered something in surprise. The student with the enviable hair, Alvarez, was nodding along like she was already one step ahead of Dr. Howe.
Howe palpated the hole in Haring’s back and pressed its edges together. “What is it, then?”
“A knife wound?” another student guessed.
“Not with these margins. It may be a stab wound, but not a knife wound.”
“Then what?” said the thick kid.
Howe said, “A round, slender weapon. An ice pick, maybe.”
“Or a crossbow bolt,” I added. “Remember that case out by the Beach Chalet...?”
The chief’s eyes were sparkling again. “You see a lot of crossbow injuries on construction sites, Dr. Teska?”
Patty Alvarez beat me to it.
“A screwdriver!”
Howe smiled tightly and nodded. “I’ve seen screwdriver wounds just like this.”
I winked at Alvarez. She beamed. It was adorable.
“Take histology sections of the entry and the wound track,” Howe said. “Maybe it’ll tell us something. Follow up with Homicide before the end of business today. Call CSI, too, and have them look out for screwdrivers.”
The boss stretched his neck up and closed his eyes. The air-conditioning tossed his thin handful of hairs around. “The press will be coming after you. You will have no comment. I’d advise you to put a hold on the body for now, make sure you cover your bases. This is high profile.”
I caught Yarina’s attention. “You got that?”
“In cooler he goes.”
I cast my voice across the room again, toward the workman’s trousers perched on the stepladder. “Hey, Denis—how’s things in the cold storage room? Did climate control fail in there, too?”
Monaghan descended, peered over at me. “Sorry, didn’t catch that. What’d you need?”
I repeated the question about the cooler.
“Which one’s that?” he said.
I pointed to it.
“Oh, that area’s not affected,” Monaghan said. “Completely separate controls, it’s been working fine all along.”
I cast my eyes skyward and pressed my gloved hands together.
“Dzięki Ci, Boże. Thank You for small favors.”