The next two days were surprisingly quiet. I convinced my father to extend his overseas trip an extra week, so he decided to take a train down to Paris and attend the famous Paris Jazz Festival. I had an entirely new security system installed in his house, with cameras that could be controlled remotely via my phone. Burke reported that the CPD finally got an address for Bianca Wembley in Lakeview. Connelly had gone quiet and hadn’t been to his office since the night we talked. Simon had called, looking for an update, and Bailey had sent a message wanting to arrange another meeting. Penny and I hit a round at Medinah Country Club, where I played the front nine like I had never been to a golf course before, then turned around after lunch and amazingly shot even par on the back nine.
I had been sitting at my desk doing an internet search on Eagle Rock and coming up with little that seemed connected to Thompson, except for the fact that there was a small neighborhood located in Northeast LA between Glendale and Pasadena with the same name. I made a note to look into that. Maybe in that conversation Flavius overheard, Thompson was making an arrangement to meet the woman and man in Eagle Rock. I had just clicked on a link about the neighborhood when my phone buzzed. It was Dr. Ellison.
“I thought you had forgotten about me,” I said.
“Not at all,” he said. “I wanted to make sure I had my thoughts sorted out correctly before getting back to you.”
“You found something?”
“For sure, but before I give you my impressions, can you give me a little more background about this young woman?”
I told him about the circumstances surrounding Bianca’s death and how she had finally been identified. I didn’t mention Connelly or Greene or anything to do with Kantor.
“And the pathologist who carried out this exam, is she new?” he said. “I don’t recognize her name.”
“I’m not sure,” I said. “But I can check it out and get back to you. I know they recently had a mass hiring to help them get through the backlog of bodies they always seem to have.”
“Well, I’m going to be honest,” he said. “I don’t like to criticize someone else’s work, but this report you sent me is badly missing the mark. It almost strikes me as the work of a young pathology resident just learning the trade.”
“What’s bothering you?”
“I don’t have a problem with the exam itself, but the conclusion doesn’t match the findings. I’ve listed five areas of concern. Do you have the time now to discuss them?”
“Absolutely.” I grabbed my case pad, turned to a blank sheet, and wrote Bianca Wembley autopsy at the top of the page.
“Let me start with the big picture,” Dr. Ellison said. “This appears to be an otherwise healthy young woman who had a few incidental findings, like a small mitral valve in her heart, a slight lateral curvature of the spine, and a one-inch leg-length discrepancy.”
“Could any of these things contribute to her death?”
“Not at all. That’s why these kinds of findings are called ‘incidental.’ You just happen to find them at autopsy; otherwise, you might never even know they existed.”
“Don’t most of us have one leg that’s longer than the other?” I said. “Or is that just one of those urban myths?”
“No, it’s very true. Some estimates are that between forty to seventy percent of the population has some degree of limb discrepancy. But those are typically small, an eighth or quarter of an inch. When the difference is half an inch or more, and in her case, an inch, then that could start presenting problems with walking, and if that’s not addressed correctly, it could eventually lead to joint or spine issues from the constant imbalance. That might explain the slight curvature they found in her spinal column. This discrepancy is also enough to cause her to noticeably limp if her shoes aren’t properly adjusted or fitted with a prosthetic. But once again, that was just an incidental finding. Let’s go through the things that raised red flags for me. Let’s go in descending anatomical order from the superior aspect of the body to inferior. Were you able to see the body yourself either at the scene or in the ME’s office?”
“No.”
“Do you have any photographs of the deceased?”
“I’ve searched online but can’t find any images of her.”
“I ask because the description of her face coloration caught my attention but doesn’t surprise me. Her skin was a darker hue, and that’s likely from what’s called venous congestion, where the veins in the neck have been blocked and the blood can’t flow freely, thus leading to congestion, which can manifest in the skin becoming a darker color.”
“Does that indicate hanging or something else?”
“It indicates she died from asphyxiation, which is basically a death from interruption of breathing or inadequate oxygen supply. But hanging is not the only way to develop this discoloration; strangulation can do it also. That’s something to keep in mind as you go through the possible mechanisms of death.”
I took copious notes so that when I reviewed everything in the file, I had the reference information I needed to make a well-informed assessment of the facts.
“My next area of interest is the eyes,” Dr. Ellison said, “particularly the conjunctival surface of the eyelids. Both eyelids had petechiae, which are round pinpoint red spots resulting from localized bleeding. This happens for two main reasons. When a person is hypoxic, or not getting enough oxygen, and when there’s an acute increase in the blood pressure inside the veins of the neck and head. This is commonly found in both a hanging and manual or ligature strangulation.”
“So just to be clear, this could be another sign that it wasn’t a hanging?”
“Precisely. Next on the list, the periorbital abrasions.”
“Which means?”
“Several areas around her mouth showed skin irritation and translucency that had clear lines of demarcation. This is significant, because let’s say it was something like an allergic rash, then you might not expect the borders to be so well-defined. They tend to be irregular. But in this case, there’s such a clear definition of the affected areas, it makes me think of some type of adhesive covering.”
“Like a Band-Aid,” I said.
“Or duct tape,” Dr. Ellison said. “But unfortunately, the pathologist doesn’t list this as a possibility for the periorbital abrasions. In fact, she never addresses this at all.”
“What do you think the skin changes mean?”
“That her mouth was duct-taped.”
“Why would someone who’s about to commit suicide duct-tape her own mouth, remove the duct tape, then hang herself?”
“When you put it like that, it doesn’t make much sense at all,” Dr. Ellison said. “Which leads me to her wrists. The pathologist reports that several markings consistent with bracelet impressions were found on both wrists.”
“You don’t like it?”
“What I don’t like is that she seems to have rushed through the possibilities. It’s rational to think that a young woman might’ve been wearing bracelets. And depending on the type of bracelets they were, they could’ve left the marks that were seen around the wrists. But restraints could’ve left similar marks too. Why doesn’t she even consider that in her conclusion? She took what was the most convenient explanation, put blinders on, and stuck with it. Too expedient for my liking. I would’ve liked to see her give it more thought.”
I continued taking notes.
“My third and most significant item is the neck dissection she performed,” Dr. Ellison said. “She noted hemorrhage in several of the neck muscle layers. That’s an equivocal finding, meaning it could be the result of a hanging, or it could be the result of strangulation. But that’s not what has my interest. It’s the hyoid bone fracture that’s giving me pause.”
“What’s the hyoid bone?” I said.
“It’s a small horseshoe-shaped bone in the front of the neck along the midline. It sits just above the much larger thyroid cartilage that protects the larynx, or voice box. The fact that it was found to be fractured makes me think this was an incomplete or rushed exam.”
“Why?”
“Because a fractured hyoid typically means some type of strangulation, either manually or by ligature,” Dr. Ellison said. “In the vast majority of cases when someone dies from hanging, the hyoid bone is rarely fractured, because there’s not enough sudden pressure on the bone to cause it to break. The exception is judicial hangings.”
“By judicial hangings, you mean hanging executions, like in the old days?” I said.
“Correct,” he said. “Back when they used hanging as a form of capital punishment, in almost all of those cases, if those bodies were indeed autopsied, they would’ve seen a fractured hyoid bone, as well as a fractured thyroid cartilage and one or more of the cervical spinous processes. That’s because the gallows they used to hang those sentenced to death were at least a story high. They would tie a noose around the neck, then let the body free-fall until it was violently jerked to a stop by the rope. That motion and sudden catch about the neck caused lots of fractures throughout the neck. But you don’t typically see these fractures in a simple suicide hanging. Not enough force to do that kind of damage.”
“So, what are you suggesting?”
“In some cases of hanging, examiners will order an MRI of the neck to look for things they can’t find at regular gross inspection at autopsy.”
“Which means?”
“When the pathologist does a regular autopsy, there’s only so much level of detail that can be seen with the naked eye. That’s called a gross inspection. When more detail is needed, then the pathologist can use imaging studies like a CT or MRI to get a closer look at the tissues in question.”
“I don’t remember reading anything about an MRI or CT scan,” I said.
“That’s because they weren’t done,” Dr. Ellison said.
“Was that a mistake?”
“I don’t know if I’d call it a mistake. It’s really up to the discretion and suspicions of the pathologist.”
“So if she had a high suspicion that the cause of death was something other than hanging, she might’ve ordered one or both of the studies.”
“Exactly,” Dr. Ellison said. “There are a lot of protocols in forensic pathology, but there are plenty of gray areas where the examiner needs to make decisions based on their findings, evidence presented, and their working narrative of what likely happened.”
“Would you have ordered an MRI?” I said.
“I would have, but that’s easy for me to say, sitting in the comfort of my living room and not in a cold lab.”
“What do you think happened?”
“I think someone restrained and strangled this woman, then hung her up to make it look like a suicide,” Dr. Ellison said.
“Would you be willing to bet on that?” I said.
“Not everything I own, but a damn good chunk of it.”