TWELVE

The drive to Hyannisport should have taken them only two hours, south on Route 3, and then along Route 6 into Cape Cod, but Rizzoli needed two restroom breaks along the way, so they didn’t reach the Sagamore Bridge until three in the afternoon. Once across that bridge, they were suddenly in the land of seaside vacations, the road leading through a series of small towns, like a necklace of pretty beads strung along the Cape. Rizzoli’s previous trips to Hyannisport had always been during the summertime, when the roads were clogged with cars, and lines of people in T-shirts and shorts snaked out of ice cream shops. She had never been here on a cold winter’s day like this one, when half the restaurants were shuttered, and only a few brave souls were out on the sidewalks, coats buttoned up against the wind.

Frost turned onto Ocean Street and murmured in wonder: “Man. Will you look at the size of these homes.”

“Wanna move in?” said Rizzoli.

“Maybe when I earn my first ten million.”

“Tell Alice she’d better get cracking on that first million, ’cause you sure aren’t gonna make it on your salary.”

Their written directions took them past a pair of granite pillars, and down a broad driveway to a handsome house near the water’s edge. Rizzoli stepped out of the car and paused, shivering in the wind, to admire the salt-silvered shingles, the three turrets facing the sea.

“Can you believe she left all this to become a nun?” she said.

“When God calls you, I guess you gotta go.”

She shook her head. “Me? I would’ve let him keep ringing.”

They walked up the porch steps and Frost pressed the doorbell.

It was answered by a small dark-haired woman who opened the door just a crack to look at them.

“We’re from Boston PD,” said Rizzoli. “We called earlier. Here to see Mrs. Maginnes.”

The woman nodded and stepped aside to let them in. “She’s in the Sea Room. Let me show you the way.”

They walked across polished teak floors, past walls hung with paintings of ships and stormy seas. Rizzoli imagined young Camille growing up in this house, running across this gleaming floor. Or did she run? Was she allowed only to walk, quietly and sedately, as she wandered among the antiques?

The woman led them into a vast room where floor-to-ceiling windows faced the sea. The view of gray, windswept water was so dramatic that it instantly captured Rizzoli’s gaze and she did not, at first, focus on anything else. But even as she stared at the water, she was aware of the sour odor that hung in the room. The smell of urine.

She turned to look at the source of that smell: a man lying in a hospital bed near the windows, as though displayed like a piece of living art. Seated in a chair beside him was an auburn-haired woman, who now rose to greet her visitors. Rizzoli saw nothing of Camille in this woman’s face. Camille’s beauty had been delicate, almost ethereal. This woman was all gloss and polish, her hair cut in a perfect helmet, her eyebrows plucked into arching gull’s wings.

“I’m Lauren Maginnes, Camille’s stepmother,” the woman said, and reached out to shake Frost’s hand. Some women ignore their own sex and focus only on the men in the room, and she was one of them, turning her full attention to Barry Frost.

Rizzoli said, “Hi, I spoke to you on the phone. I’m Detective Rizzoli. And this is Detective Frost. We’re both very sorry about your loss.”

Only then did Lauren finally deign to focus on Rizzoli. “Thank you” was all she said. She glanced at the dark-haired woman who’d shown them in. “Maria, could you tell the boys to come down and join us? The police are here.” She turned back to her guests and gestured toward a couch. “Please sit down.”

Rizzoli found herself seated closest to the hospital bed. She looked at the man’s hand, contracted into a claw, and his face, one side drooping into an immobile puddle, and she remembered the last months of her own grandfather’s life. How he had lain in his nursing-home bed, his eyes fully aware and angry, imprisoned in a body that would no longer obey his commands. She saw such awareness in this man’s eyes. He was staring straight at her, at this visitor he did not know, and she saw despair and humiliation in that gaze. The helplessness of a man whose dignity has been stolen. He could not be much older than fifty, yet already his body had betrayed him. A line of drool glistened on his chin and dribbled onto the pillow. On a nearby table were all the paraphernalia needed to keep him comfortable: cans of Ensure. Rubber gloves and Handi Wipes. A box of adult diapers. Your whole life reduced to a tabletop’s worth of hygiene products.

“Our evening shift nurse is running a little late, so I hope you don’t mind sitting here while I keep an eye on Randall,” said Lauren. “We moved him into this room because he’s always loved the sea. Now he can look at it all the time.” She reached for a tissue and gently dabbed the drool from his mouth. “There. There, now.” She turned and looked at the two detectives. “You see why I didn’t want to drive all the way up to Boston. I don’t like to leave him for too long with the nurses. He gets agitated. He can’t talk, but I know he misses me when I’m gone.”

Lauren sat back down in the armchair and focused on Frost. “Have you made any progress with the investigation?”

Once again, it was Rizzoli who responded, determined to hold this woman’s attention, and irritated that it kept slipping away from her.

“We’re following some new leads,” she said.

“But you didn’t drive all the way to Hyannis just to tell me that.”

“No. We came to talk about some issues we felt more comfortable handling in person.”

“And you wanted to look us over, I imagine.”

“We wanted a sense of Camille’s background. Her family.”

“Well, here we are.” Lauren waved her arm. “This is the house she grew up in. It’s hard to imagine, isn’t it? Why she’d leave this for a convent. Randall gave her everything any girl could ask for. A brand-new BMW for her birthday. Her own pony. A closet full of dresses that she hardly ever wore. Instead, she chose to wear black for the rest of her life. She chose …” Lauren shook her head. “We still don’t get it.”

“You were both unhappy about her decision?”

“Oh, I could live with it. After all, it was her life. But Randall never accepted it. He kept hoping she’d change her mind. That she’d get tired of whatever it is nuns do all day, and she’d finally come home.” She looked at her husband, lying mute in the bed. “I think that’s why he had his stroke. She was his only child, and he couldn’t believe she left him.”

“What about Camille’s birth mother, Mrs. Maginnes? You told me on the phone that she was dead.”

“Camille was only eight years old when it happened.”

“When what happened?”

“Well, they called it an accidental overdose, but are any of those really accidents? Randall had already been widowed several years when I met him. I guess you could call us a reconstituted family. I have two sons from my first marriage, and Randall had Camille.”

“How long have you and Randall been married?”

“Almost seven years now.” She looked at her husband. Added, with a note of resignation, “For better or for worse.”

“Were you and your stepdaughter close? Did she share much with you?”

“Camille?” Lauren shook her head. “I have to be perfectly honest. We never really bonded, if that’s what you’re asking. She was already thirteen when I met Randall, and you know what kids are like at that age. They want nothing to do with adults. It’s not that she treated me like her evil stepmother or anything. We just didn’t, well, connect, I guess. I made the effort, I really did, but she was always so …” Lauren suddenly stopped, as though afraid she’d say something she shouldn’t.

“What’s the word you’re looking for, Mrs. Maginnes?”

Lauren thought about it. “Strange,” she said finally. “Camille was strange.” She looked at her husband, who was staring at her, and quickly said, “I’m sorry, Randall. I know it’s awful for me to say that, but these are policemen. They want to hear the truth.”

“What do you mean by strange?” asked Frost.

“You know how, when you walk into a party, you sometimes spot someone who’s standing all alone?” said Lauren. “Someone who won’t look you in the eye? She was always off by herself in a corner, or hiding out in her room. It never occurred to us what she was doing up there. Praying! Down on her knees and praying. Reading those books she got from one of the Catholic girls at school. We’re not even Catholic, we’re Presbyterians. But there she was, locked in her room. Whipping herself with a belt, can you believe it? To make herself pure. Where do they get such ideas?”

Outside, the wind sprayed sea salt on the windows. Randall Maginnes gave a soft moan. Rizzoli noticed that he was looking straight at her. She gazed back at him, wondering how much of this conversation he understood. Full comprehension would be the greater curse, she thought. To know everything that was going on around you. To know your daughter, your only natural child, is dead. To know your wife feels burdened by your care. To know that the terrible odor you’re forced to inhale is your own.

She heard footsteps and turned to see two young men walk into the room. Clearly they were Lauren’s sons, with the same reddish-brown hair, the same handsome features stamped on their faces. Though both were dressed casually in jeans and crew-neck sweaters, they managed, like their mother, to project stylish confidence. Thoroughbreds, thought Rizzoli.

She reached out to shake their hands. Did it firmly, establishing her authority. “I’m Detective Rizzoli,” she said.

“My sons, Blake and Justin,” said Lauren. “They’re home from college for the holidays.”

My sons, she had said. Not our sons. In this family, reconstitution had not completely blended the lines of love. Even after seven years of marriage, her sons were still hers, and Randall’s daughter was his.

“These are our two budding lawyers in the family,” said Lauren. “With all the arguments they have around the dinner table, they’ve had plenty of practice for the courtroom.”

“Discussions, Mom,” said Blake. “We call them discussions.”

“Sometimes I can’t tell the difference.”

The boys sat down with the easy grace of athletes, and looked at Rizzoli, as though expecting the entertainment to begin.

“In college, huh?” she said. “Where do you boys go?”

“I’m at Amherst,” said Blake. “And Justin’s at Bowdoin.”

Both within easy driving distance to Boston.

“And you want to be lawyers? Both of you?”

“I’ve already got my application in to law schools,” said Blake. “I’m thinking of entertainment law. Maybe work out in California. I’m getting a minor in film studies, so I think I’m laying a pretty good foundation for it.”

“Yeah, and he wants to hang out with cute actresses, too,” said Justin. For that comment, he got a playful jab in the ribs. “Well, he does!”

Rizzoli wondered about two brothers who could exchange such lighthearted banter while their stepsister lay, so recently deceased, in the morgue.

She asked, “When did you two last see your sister?”

Blake and Justin looked at each other. Said, almost in unison, “Grandma’s funeral.”

“That was in March?” She looked at Lauren. “When Camille came home for a visit?”

Lauren nodded. “We had to petition the church to let her come home for the services. It’s like asking for a prisoner’s parole. I couldn’t believe it when they didn’t let her come home again in April, after Randall had his stroke. Her own father! And she just accepted their decision. Just did what they told her to do. You have to wonder what goes on inside those convents, that they’re so afraid to let them out. What sorts of abuse they’re hiding. But that’s probably why she liked being there.”

“Why would you think that?”

“Because it’s what she craved. Punishment. Pain.”

“Camille?”

“I told you, Detective, she was strange. When she was sixteen, she took off her shoes and went walking barefoot. In January. It was ten degrees outside! The maid found her standing in the snow. Of course, all our neighbors soon heard about it as well. We had to take her to the hospital for frostbite. She told the doctor she did it because the saints had suffered, and she wanted to feel pain, too. She thought it would bring her closer to God.” Lauren shook her head. “What can you do with a girl like that?”

Love her, thought Rizzoli. Try to understand her.

“I wanted her to see a psychiatrist, but Randall wouldn’t hear of it. He never, ever admitted that his own daughter was …” Lauren paused.

“Just say it, Mom,” said Blake. “She was crazy. That’s what we all thought.”

Camille’s father made a soft moan.

Lauren rose to wipe another thread of drool from his mouth. “Where is that nurse, anyway? She was supposed to be here at three.”

“When Camille came home in March, how long did she stay?” asked Frost.

Lauren looked at him, distracted. “About a week. She could have stayed longer, but she chose to go back to the convent early.”

“Why?”

“I guess she didn’t like being around all these people. We had a lot of my relatives up from Newport for the funeral.”

“You did tell us she was reclusive.”

“That’s an understatement.”

Rizzoli asked, “Did she have many friends, Mrs. Maginnes?”

“If she did, she never brought any of them home to meet us.”

“How about at school?” Rizzoli looked at the two boys, who glanced at each other.

Justin said, with unnecessary callousness, “Only the wallflower crowd.”

“I meant boyfriends.”

Lauren gave a startled laugh. “Boyfriends? When all she dreamed about was becoming the bride of Christ?”

“She was an attractive young woman,” said Rizzoli. “Maybe you didn’t see it, but I’m sure there were boys who noticed it. Boys who were interested in her.” She looked at Lauren’s sons.

“No one wanted to go out with her,” said Justin. “They’d get laughed at.”

“And when she came home, in March? Did she spend time with any friends? Did any men seem particularly interested in her?”

“Why do you keep asking about boyfriends?” said Lauren.

Rizzoli could think of no way to avoid revealing the truth. “I’m sorry to have to tell you this. But shortly before Camille was murdered, she bore a child. A baby who died at birth.” She looked at the brothers.

They stared back at her with equally stunned expressions.

For a moment, the only sound in the room was the wind whipping off the sea, rattling the windows.

Lauren said, “Haven’t you been reading the news? All those terrible things the priests have been doing? She’s been in a convent for the last two years! She’s been under their supervision, their authority. You should talk to them.”

“We’ve already questioned the one priest who had access to the convent. He willingly gave us his DNA. Those tests are pending.”

“So you don’t even know yet if he’s the father. Why bother us with these questions?”

“The baby would have been conceived sometime in March, Mrs. Maginnes. The month she came home for that funeral.”

“And you think that it happened here?”

“You had a house full of guests.”

“What are you asking me to do? Call up every man who happened to visit here that week? ‘Oh by the way, did you sleep with my stepdaughter?’ ”

“We have the infant’s DNA. With your help, we might be able to identify the father.”

Lauren shot to her feet. “I’d like you to leave now.”

“Your stepdaughter’s dead. Don’t you want us to find her killer?”

“You’re looking in the wrong place.” She walked to the doorway and called out: “Maria! Can you show these policemen out?”

“DNA would give us the answer, Mrs. Maginnes. With just a few swabs, we could put all suspicions to rest.”

Lauren turned and faced her. “Then start with the priests. And leave my family alone.”

         

Rizzoli slid into the car and pulled the door shut. As Frost warmed the engine, she gazed at the house, and remembered how impressed she’d been when she’d caught her first glimpse of it.

Before she had met the people inside.

“Now I know why Camille left home,” she said. “Imagine growing up in that house. With those brothers. With that stepmother.”

“They seemed a lot more upset about our questions than about the girl’s death.”

As they drove through the granite pillars, Rizzoli took one last backward look at the house. Imagined a young girl, gliding like a wraith among those vast rooms. A girl derided by her stepbrothers, ignored by her stepmother. A girl whose hopes and dreams are ridiculed by those who are supposed to love her. Every day in that house would bring another punishing blow to your soul, more painful than the sting of frostbite as you walk barefoot in the snow. You want to be closer to God, to know the unconditional warmth of His love. For that they laugh at you, or pity you, or tell you that you’re a candidate for the psychiatrist’s couch.

No wonder the walls of the convent had seemed so welcoming.

Rizzoli sighed and turned to look at the road that stretched ahead. “Let’s go home,” she said.

         

“This diagnosis has me stumped,” said Maura.

She laid out a series of digital photographs on the conference room table. Her four colleagues did not so much as flinch at the images, for they had all seen far worse sights in the autopsy lab than these views of rat-bitten skin and angry nodules. They seemed far more focused on the box of fresh blueberry muffins that Louise had brought in that morning for case conference, an offering that the doctors were happily devouring, even as they stared at stomach-turning photos. Those who work with the dead learn to keep the sights and smells of their jobs from ruining their appetites, and among the pathologists now seated at the table was one known to be particularly fond of seared foie gras, a pleasure undimmed by the fact he dissected human livers by day. Judging by his ample belly, nothing ruined Dr. Abe Bristol’s appetite, and he happily munched on his third muffin as Maura set down the last of the images.

“This is your Jane Doe?” asked Dr. Costas.

Maura nodded. “Female, approximate age thirty to forty-five, with a gunshot wound to the chest. She was found about thirty-six hours after death inside an abandoned building. There was postmortem excision of the face, as well as amputations of the hands and the feet.”

“Whoa. There’s a sick boy for you.”

“It’s these skin lesions that stump me,” she said, gesturing to the array of photos. “The rodents did some damage, but there’s enough intact skin left to see the gross appearance of these underlying lesions.”

Dr. Costas picked up one of the photos. “I’m no expert,” he said solemnly, “but I’d call this a classic case of red bumps.”

Everyone laughed. Physicians flummoxed by skin lesions often resorted to simply describing the skin’s appearance, without knowing its cause. Red bumps could be caused by anything from a viral infection to autoimmune disease, and few skin lesions are unique enough to point to an immediate diagnosis.

Dr. Bristol stopped chewing his muffin long enough to point to one of the photos and say, “You’ve got some ulcerations here.”

“Yes, some of the nodules have shallow ulcerations with crust formation. And a few have the silvery scales you’d see in psoriasis.”

“Bacterial cultures?”

“Nothing unusual is growing out. Just Staph. epidermidis.”

Staph epi was a common skin bacteria, and Bristol merely shrugged. “Contaminant.”

“What about the skin biopsies?” asked Costas.

“I looked at the slides yesterday,” said Maura. “There are acute inflammatory changes. Edema, infiltration by granulocytes. Some deep micro-abscesses. There are also inflammatory changes in the blood vessels as well.”

“And you have no bacteria growing?”

“Both the Gram stain and Fite Faraco stains are negative for bacteria. These are sterile abscesses.”

“You already know the cause of death, right?” said Bristol, his dark beard catching the crumbs of his muffin. “Does it really matter what these nodules are?”

“I hate to think I’m missing something obvious here. We have no identification on this victim. We don’t know anything about her, except for the cause of death and the fact she was covered with these lesions.”

“Well, what’s your diagnosis?”

Maura looked down at the ugly swellings, like a mountain range of carbuncles across the victim’s skin. “Erythema nodosum,” she said.

“Cause?”

She shrugged. “Idiopathic.” Meaning, quite simply, cause unknown.

Costas laughed. “There’s a wastebasket diagnosis for you.”

“I don’t know what else to call it.”

“Neither do we,” said Bristol. “Erythema nodosum works for me.”

Back at her desk, Maura reviewed the typed autopsy report for Rat Lady, which she had dictated earlier, and felt dissatisfied as she signed it. She knew the victim’s approximate time of death, and the cause of death. She knew the woman was most likely poor, and that she had surely suffered from the humiliation of her appearance.

She looked down at the box of biopsy slides, labeled with the name Jane Doe and the case number. She pulled out one of the slides and slid it under the microscope lens. Swirls of pink and purple came into focus through the eyepiece. It was a hematoxylin and eosin stain of the skin. She saw the dark stipples of acute inflammatory cells, saw the fibrous circle of a blood vessel infiltrated by white cells, signs that the body was fighting back, sending its soldiers of immune cells into battle against … what?

Where was the enemy?

She sat back in her chair, thinking of what she’d seen on autopsy. A woman with no hands or face, mutilated by a killer who harvested identities as well as lives.

But why the feet? Why did he take the feet?

This is a killer who seems to operate with cool logic, she thought, not twisted perversions. He shoots to kill, using an efficiently lethal bullet. He strips the victim but does not sexually abuse her. He amputates the hands and feet and peels off the face. Then he leaves the corpse in a place where its skin will soon be gnawed away by scavengers.

It kept coming back to the feet. The removal of the feet was not logical.

She retrieved Rat Lady’s X-ray envelope and slid the ankle films onto the light box. Once again, the abrupt demarcation of severed flesh shocked her, but she saw nothing new here, no clues that would explain the killer’s motive for the amputation.

She took the films down, replaced them with the skull films, frontal and lateral views. She stood gazing at the bones of Rat Lady’s face, and tried to envision what that face might have looked like. No older than forty-five, she thought, yet already you have lost your upper teeth. Already, you have the jaw of an elderly woman, the bones of your face rotting from within, your nose sinking into a widening crater. And scattered across your torso and limbs are ugly nodules. Just a glance in the mirror would be painful. And then to step outside, into the eyes of the public …

She stared at the bones, glowing on the light box. And she thought: I know why the killer took the feet.

         

It was only two days before Christmas, and when Maura walked onto the Harvard campus, she found it almost deserted, the Yard a broad expanse of white, scarcely marred by footprints. She tramped along the walkway, carrying her briefcase and a large envelope of X rays, and could smell, in the air, the metallic tang of a coming snowfall. A few dead leaves clung, shivering, to bare trees. Some would view this scene as a holiday postcard with a Season’s Greeting caption, but she saw only the monotonous grays of winter, a season she was already weary of.

By the time she reached Harvard’s Peabody Museum of Archaeology, cold water had seeped into her socks and the hems of her pant legs were soaked. She stomped off the snow and walked into a building that smelled of history. Wooden steps creaked as she went down the stairwell to the basement.

The first thing she noticed, as she stepped inside the dim office of Dr. Julie Cawley, were the human skulls—at least a dozen of them, lining the shelves. A lone window, set high in the wall, was half covered by snow, and the light that managed to seep through shone down directly on Dr. Cawley’s head. She was a handsome woman, with upswept gray hair that looked pewter in the wintry light.

They shook hands, an oddly masculine greeting between two women.

“Thank you for seeing me,” said Maura.

“I’m rather looking forward to what you have to show me.” Dr. Cawley turned on a lamp. In its yellowish glow, the room suddenly seemed warmer. Cosier. “I like to work in the dark,” she said, indicating the glow of the laptop on her desk. “It keeps me focused. But is hard on these middle-aged eyes.”

Maura opened her briefcase and removed a folder of digital prints. “These are the photos I took of the deceased. I’m afraid they’re not very pleasant to look at.”

Dr. Cawley opened the folder and paused, staring at the photo of Rat Lady’s mutilated face. “It’s been a while since I’ve attended an autopsy. I certainly never enjoyed it.” She sat down behind the desk and took a deep breath. “Bones seem so much cleaner. Somehow less personal. It’s the sight of flesh that turns the stomach.”

“I also brought her X rays, if you’d rather look at those first.”

“No, I do need to look at these. I need to see the skin.” Slowly she flipped to the next photo. Stopped and stared in horror. “Dear god,” she murmured. “What happened to the hands?”

“They were removed.”

Cawley shot her a bewildered look. “By whom?”

“The killer, we assume. Both hands were amputated. So were parts of the feet.”

“The face, the hands, the feet—those are the first things I’d look at to make this diagnosis.”

“Which could be the reason why he removed them. But there are other photos in there that might help you. The skin lesions.”

Cawley turned to the next set of images. “Yes,” she murmured, as she slowly flipped through them. “This certainly could be …”

Maura’s gaze lifted to the row of skulls on the shelf, and she wondered how Cawley could work in this office, with all those empty eye sockets staring down at her. She thought of her own office, with its potted plants and floral paintings—nothing on the walls to remind her of death.

But Cawley had chosen to surround herself with the evidence of her own mortality. A professor of medical history, she was a physician as well as an historian, a woman who could read a lifetime’s worth of miseries etched in the bones of the dead. She could look at the skulls on her shelf and see, in each, a personal history of pain. An old fracture or an impacted wisdom tooth or a jawbone infiltrated by tumor. Long after the flesh melts away, the bones still tell their stories. And judging by the many photos of Dr. Cawley taken at archaeological dig sites around the world, she had been mining these stories for decades.

Cawley looked up from a photo of one of the skin lesions. “Some of these do bear a resemblance to psoriasis. I can see why it was one of the diagnoses you considered. These could also be leukemic infiltrates. But we’re talking about a great masquerader. It can look like many different things. I assume you did skin biopsies?”

“Yes, including stains for acid-fast bacilli.”

“And?”

“I saw none.”

Cawley shrugged. “She may have received treatment. In which case there’d be no bacilli still present on biopsy.”

“That’s why I came to you. Without active disease, without bacilli to identify, I’m at a loss as to how to make this diagnosis.”

“Let me see the X rays.”

Maura handed her the large envelope of films. Dr. Cawley carried them to a viewing box mounted on her wall. In that office cluttered with artifacts from the past—skulls and old books and several decades’ worth of photos—the light box stood out as a starkly modern feature. Cawley rifled through the X rays and finally slid one under the mounting clips.

It was a skull film, viewed face-on. Beneath the mutilated soft tissues, the bony structures of the face remained intact, glowing like a death’s head against the black background. Cawley studied the film for a moment, then pulled it down and slid on a lateral view, taken of the skull’s profile.

“Ah. Here we go,” she murmured.

“What?”

“See here? Where the anterior nasal spine should be?” Cawley traced her finger down what should have been the slope of the nose. “There’s been advanced bone atrophy. In fact, there’s almost complete obliteration of the nasal spine.” She crossed to the shelf of skulls and took one down. “Here, let me show you an example. This particular skull was exhumed from a medieval grave site in Denmark. It was buried in a desolate spot, far outside the churchyard. You see here, where inflammatory changes have destroyed so much bony tissue that there’s just a gaping hole where the nose would be. If we were to boil off the soft tissues from your victim there—” She pointed to the X ray “—her skull would look very much like this one.”

“It’s not postmortem damage? Could the nasal spine have been cracked off when the face was excised?”

“It wouldn’t account for the severity of changes I see on that X ray. And there’s more.” Dr. Cawley set down the skull and pointed to the film. “You’ve got atrophy and recession of the maxillary bone. It’s so severe that the front upper teeth have been undermined and have fallen out.”

“I’d assumed it was due to poor dental care.”

“That may have contributed. But this is something else. This is far more than just advanced gum disease.” She looked at Maura. “Did you do the other X-ray projections I suggested?”

“They’re in the envelope. We did a reverse Waters shot as well as a periapical series to highlight the maxillary landmarks.”

Cawley reached inside and pulled out more X rays. She clipped up a periapical film, showing the floor of the nasal cavity. For a moment she said nothing, her gaze transfixed by the white glow of bone.

“I haven’t seen a case like this in years,” she murmured in wonder.

“Then the X rays are diagnostic?”

Dr. Cawley seemed to shake herself from her trance. She turned and picked up the skull from her desk. “Here,” she said, turning the skull upside down to show the bony roof of the hard palate. “Do you see how there’s been pitting and atrophy of the alveolar process of the maxilla? Inflammation has eaten away this bone. The gums have receded so badly that the front teeth fell out. But the atrophy didn’t stop there. Inflammation continued to chew away at the bone, destroying not just the palate, but also the turbinate bones inside the nose. The face was literally eaten away, from the inside, until the hard palate perforated and collapsed.”

“And how disfigured would this woman have been?”

Cawley turned and looked at the X ray of Rat Lady. “If this were medieval times, she would have been an object of horror.”

“Then this is enough for you to make a diagnosis?”

Dr. Cawley nodded. “This woman almost certainly had Hansen’s disease.”