THE CORPSE IS STRETCHED OUT ON THE TABLE, COVERED BY A green sheet that exposes only the head and feet. Kate Ottoway, a highly experienced doctor of osteopathic medicine, kicks off by telling us that death was near instantaneous. The shell narrowly missed the victim’s brainstem before dumping the rest of its energy into his skull cavity.
‘DJ’ Wharton, a bull-necked FBI agent who attended the autopsy on behalf of the Feds and the US Attorney’s Office, who are leading the investigation into Guido’s death, has already told Hetta that it was a Sierra MatchKing 30-caliber, 168-grain hollow-point boat-tail bullet: the ammunition used by the MPD’s sniper community.
DJ’s thick head of hair matches the stainless steel furniture and fittings. He says little, but has not been unhelpful. He’s built like a lineman and looks like an old-fashioned gumshoe. There is nothing remotely CSI about him. It’s no accident that he and Lefortz turn out to be drinking buddies.
Guido was a healthy thirty-five to forty-year-old male carrying no detectable traces of recreational or prescription drugs or alcohol at the time of death. But there’s no hiding the fact that he’s really been through the wars, the most visible evidence of which is the knotted, red and purple scar tissue that covers his upper body, face and head.
I have seen plenty of keloid before, but this is particularly livid and as hard as vulcanized rubber. Kate reckons the burn occurred around five to seven years ago, and postdated a second serious injury.
The bullet delivered three impacts: the relatively small entry hole in the occipital bone; the pressure wave caused by the expansion of the bullet within the brain tissue, ripping the top of the head in two; and then the explosive exit wound around the right eye.
His skull was held together by the mask, but effectively unzipped.
She invites us to examine a depressed fracture in the top rear area of the skull – visible as a spider’s web of hairline cracks – that caused severe bruising and hemorrhaging to the posterior parietal cortex. From the healing patterns, she estimates the injury to be around fifteen years old. Though skillfully re-elevated by a neurosurgeon, one of its consequences would have been memory loss.
Hetta glances at me. ‘What causes damage like that?’
Kate removes her eyeglasses, takes a moment to massage the bridge of her nose then replaces them. Her face is strong yet fragile, her hair long and prematurely gray. I guess she’s in her early forties. I want to ask what made her devote her considerable surgical talents to the dissection of the dead, but I don’t.
‘It’s difficult to be precise,’ she says. ‘But we’re talking a blunt trauma. I’ve seen injuries like this in car accidents when the victim has hit the dash. It could also have been caused by a pressure wave. An explosion. If that’s the case, then he was close to the blast and remarkably lucky to have survived. Fewer than ten per cent of people with severe diffuse axonal injury ever regain consciousness.’
The explosion theory is reinforced by our exchange in the tower, and by what Kate shows us when she pulls back the sheet to expose the torso.
Prominent on the upper right arm is a tattoo, sleeve art, a large, intertwined motif that includes an eagle’s wings, a skull, a globe, the Stars and Stripes, and some lettering that’s hard to make out where it has blended with the blood that’s pooled and congealed in multiple hues of black and blue on the entire underside of the body.
Hetta leans forward. ‘No Greater Love …’ She traces the words with a finger held just above the skin. ‘He was a Marine.’
‘The tattoo is confirmatory evidence regarding the age range,’ Agent Wharton pipes up. ‘In 2007, the Corps banned sleeve tattoos – any large tattoos or collections of tattoos, in fact, on the arms or legs. So our guy appears to have joined the Marines prior to 2007 and most likely left – if the burn is anything to go by – around five years ago, having sustained a brain injury along the way.’
‘I wish it were that simple. If he sustained the brain injury on combat operations, it’s unlikely he’d have been allowed to return anywhere near the front line.’ I don’t want to sound unduly pessimistic, but at MacDill we treated thousands of veterans with traumatic brain injuries. Half a million US service personnel have returned from Iraq, Afghanistan and other theaters of war in the past two decades with some kind of TBI. ‘The dozen or so Defense and Veterans Brain Injury Centers around the country, including the one I established at MacDill, will have records of the injuries. But it will take time to crunch through the data. We should run his DNA through the Armed Forces DNA Identification Lab too.’
The lab has swabbed samples from anyone who’s served in the military since 9/11, but their results won’t come in overnight either. Which leaves fingerprinting or a visual identification – somebody, somewhere, who will recognize the description of his burns – as the best short-term route. We’re back to square one.
I wait for Kate to replace the sheet, but before any of us can look away, she takes the back edge of Guido’s scalp between her thumb and forefinger and gently lifts and repositions it on what is left of his skull.
Hetta doesn’t move, but Wharton bounces his not inconsiderable weight from foot to foot, as if he is contemplating escape.
With the blood almost drained from it, the knotted scar tissue of the dead man’s face reminds me of Halloween masks we used to buy as kids. It’s hard not to be drawn to the jagged starfish of bone, flesh and skin that stares back in place of the right eye, though the doctor is trying to direct our attention to something else: a set of small lesions on the surface of the keloid that run around the head, fractionally above the ears and several centimeters above the eyes – roughly the line a hat would rest on. They are barely noticeable, but unmistakably there: six of them, evenly spaced and roughly the size and shape of a dime.
‘What do you think made those?’ Hetta asks.
‘I really don’t know – but whatever it was, it went on long enough to leave a lasting impression on …’ Kate stops. There is no medical vernacular – no language of any kind – to describe what is left of him.
Hart and I walk out into the fading light. It has stopped snowing, but the low cloud seems to indicate more on its way.
As I turn my phone back on, it vibrates with a dozen messages, one of them from Molly, reminding me of the Deputy Chief of Staff’s Moscow planning meeting that’s about to start in the Roosevelt Room.
The other message I pick out is from Lefortz. He suggests we meet for a drink at the usual place, a sports bar between the Whitehurst Freeway and the Georgetown Canal. I’ll go there after I’ve finished my weekly meeting with my mentor, Ted van Buren. TVB’s study is in the Medical and Dental Building, part of Georgetown’s Department of Medicine. The bar is a fifteen-minute walk.
Hetta is heading to her office several floors below Cabot’s suite and offers me a ride. She is as silent as I am. Perhaps we’re thinking the same thoughts. I see the look in Guido’s eyes, the blood bubbling in his throat; his effort to signal me with his hand.
The informal term amongst pathologists for what we have just witnessed is a ‘human canoe’ – a body with nothing in it.
Of Guido’s three manifestations of trauma, only his memory lapses could be deduced from the pathology.
I’m missing something, a connection between the brain injury, the stammer and the myoclonus, and it’s only when I’m sitting in my office after the Moscow planning meeting that I finally see it.
Shortly after our new trauma center opened, we received a soldier who had been running away from a suspected roadside bomb when it detonated in Sarwan Qala, a godforsaken hole in Afghanistan. The blast blew him clean off his feet and threw him against the side of a building, which then collapsed on him.
He suffered a severe TBI, and was placed in an induced coma and flown back to MacDill. When we started to bring him out, he began kicking off all the bedclothes. Every time we replaced them, he kicked them off again, as if his life depended on it.
The nurses were quietly infuriated, the doctors baffled. It only stopped when we brought him back to full consciousness. And then we realized he’d been sprinting, as he had been when the bomb had detonated, because his life did depend on it. He was returning to his primal objective – survival – when he’d been robbed of consciousness.
Cognitively, he made a near full recovery. But he was left with a reflexive tic in his right leg, because the trauma had imprinted: the messaging had locked deeply in his body as well as in his brain.
For a while, he was rendered speechless, too, but we sorted that out through cognitive behavioral therapy. He was left with a mild stammer. The myoclonus, though, remained defiant, until we treated it subconsciously.
Doctor Mo Kerchorian, a genius I studied with alongside Ted van Buren, had developed a technique that cured his affliction. Some psychotherapists dubbed them ‘cell memories’. Part physiotherapy, part hypnosis, it had been right on the edge of the medical mainstream. Mo went on to establish a clinic within the Department of Neurosurgery at the Stanford School of Medicine, part of the Veterans’ Association Health Care System.
I glance at my watch. It’s coming up to four o’clock on the West Coast. I get three rings before going to voicemail. His youthful, heavily accented voice invites me to leave a short message.
I ask if he had ever come across a Marine on the system, probably from the Appalachian region – Kentucky, West Virginia or Tennessee, maybe – who had been treated for flashbacks that presented as cell memories.