Authors: Richard Preston
“Are you board certified?”
“Not yet,” she said.
Dudley turned to Nathanson and said in a flinty voice, “They don’t even send us a certified pathologist.”
“I’ll be taking my boards next year.” She concentrated on her green notebook.
Nathanson said, “Well—as I imagine Dr. Mellis told you, we’ve had two very unusual deaths. The girl who died yesterday, and a similar incident five days ago. The first case we noticed—”
“I noticed,” Dudley said.
“—Glenn noticed, was an unidentified homeless man. He was known locally as Harmonica Man. He was about sixty years old, and he used to ride the subway cars playing a harmonica. He had a cup and he asked for handouts. He went all over the city. I live on the East Side, and I actually remember seeing him riding the Lexington Avenue local. He died a week ago at the Times Square subway station, on the southbound platform of the Broadway line, if you know where that is.”
“I don’t know New York very well,” Austen said.
“It doesn’t matter. He died in grand mal seizures,” Nathanson said.
“It was a spectacular death,” Dudley said. “The guy seized in the middle of a crowd, he’s screaming, he bit off his tongue, he bit his hands, and he had a hemorrhage. He was D.O.A. at Bellevue. I did the autopsy, and found his tongue in his stomach. The Fire Department E.M.T. squad reported that he arched his back and froze and died on the platform that way, having eaten his tongue, and with a massive bleed from the mouth. He was with a friend of his—another homeless guy named…” He flipped through the case folder, glancing over the file. “Named Lem. No last name given. When I did the autopsy, I found that this Harmonica Man was an alcoholic with cirrhosis of the liver, and he had varicose veins in the esophagus. A vein had burst in his esophagus. That was the source of the bleed from the mouth, that plus bleeding from the tongue stump. He had brain swelling and brain damage, with hemorrhage in the midbrain. It could be a poison, a toxin. But nothing came up with the toxicology.”
“What got my attention,” Nathanson said, “was the form of the seizure—that curvature of the spine.”
“That’s less important, I think, Lex,” Dudley said.
“It’s known as an
arc de circle
seizure,” Nathanson went on, in a thoughtful way. “I looked into this. The
arc de circle
seizure was identified by the nineteenth-century French neurologist Jean-Marie Charcot. It’s a fake seizure. A real seizure doesn’t make the spine curve. But the two decedents weren’t faking—they were dying.” He turned to Austen. “This second case has gotten into the news media, and we’re under some pressure to come up with answers.”
“So you called the C.D.C., Lex—and you listened to Walt Mellis with his theories. He’s a nut,” Dudley said.
Nathanson shrugged and flashed a smile at Austen. “You’re not a nut, are you, Doctor?”
“I hope not,” she said.
Dudley stood up suddenly. “Let’s get going.” He picked up a manila file folder that had been sitting on an empty chair. “We can talk in the morgue.”
They stepped into a freight elevator. It went to the basement of the O.C.M.E. On the way down, Nathanson turned to her. “How old are you?”
“Twenty-nine.”
“Kind of young for a fed,” Glenn Dudley remarked, standing behind them.
“It’s a training job,” she said.
THE MORGUE
was in the first basement level, next to the receiving garage. A mortuary van had just pulled in, and a couple of dieners, or morgue attendants, were unloading a body covered with a sheet of blue paper. The attendants transferred the body to a mortuary gurney known as a pan, which is a sort of metal trough on wheels. The pan was shaped like a trough so that fluids would not drip out of bodies onto the floor.
The receiving garage was crowded with bright red Dumpsters marked with biohazard symbols, spiky three-lobed flowers. A sign on the wall said:
PLEASE DO NOT THROW LOOSE CLOTH OR BLOODY SHEETS ON THE DUMPSTERS
.
Nathanson approached a man dressed in a green scrub suit. “We’re ready, Ben,” he said. “Let me introduce you to our C.D.C. investigator. This is Dr. Alice Austen. And this is Ben Kly. He’ll be the attendant. Ben, we’re keeping quiet about Dr. Austen’s presence here.”
“Sure,” Kly said, and smiled. His name rhymed with “fly.” He and Austen shook hands.
Ben Kly was a slender man of medium height, an Asian-American with dark, creamy skin. He had a quiet voice. “I’ll be with you in a second,” he said. He wheeled the pan with the body on it into the hallway.
They pushed through a pair of battered swinging doors into the morgue, where they were enveloped by a thick smell, sour and penetrating—a smell as old as the world. It hung in the air like a liquescent fog, and seemed to coat the back of one’s mouth. It was the smell of bacteria converting meat into energy. The bacteria were liquefying human meat and giving off gases. In the Manhattan morgue, this smell rose and fell and changed day by day, depending on the weather and events around the city, but it never went away. The Manhattan morgue emitted an endless Gregorian chant of smell.
It was Charles Darwin who first understood that evolution is caused by natural selection, and that natural selection is death. He also understood that vast amounts of death (vast amounts of natural selection) are required to effect a small permanent change in the shape or behavior of an organism. Without huge amounts of death, organisms do not change over time. Without death, life would never have become more complex than the simplest self-copying molecules. The arms of a starfish could not have happened without countless repetitions of death. Death is the mother of structure. It took four billion years of death—a third of the age of the universe—for death to invent the human mind. Given another four billion years of death, or perhaps a hundred billion years of death, who can say that death will not create a mind so effective and subtle that it will reverse the fate of the universe and become God? The smell in the Manhattan morgue is not the smell of death; it is the smell of life changing its form. It is evidence that life is indestructible.
THE MORGUE WAS
ring-shaped, with a central rectangular core where bodies were stored inside crypts. You circled around the core to gain access to a particular crypt. The walls were made of bricks painted a pale green. The crypt doors were made of stainless steel. Various smaller rooms led off from the main room. Some of these smaller rooms were for holding severely putrefied bodies, so that the smell would not fill the morgue area.
“There’s the ladies’ room,” Nathanson said, pointing to a door off the morgue. “You can change in there.”
It was cleaner than most rest rooms in morgues. Austen found a shelf holding fresh surgical scrub suits. She removed her street shoes and took off her blouse and skirt and changed into the scrubs. Then she put on her Mighty-Tuff boots, and laced them up.
She found Nathanson, Dudley, and Kly in a storage room on the other side of the morgue, putting on the next layer of clothing. The storage room was full of metal shelves holding biosafety equipment. They put on disposable surgical gowns over their scrub suits. Over the surgical gowns they tied heavy plastic waterproof aprons. They put surgical covers on their shoes, surgical caps on their heads.
Glenn Dudley pulled a disposable button mask down over his nose and mouth. It was a soft cup made of biofilter material, like a surgeon’s mask. It had a blue button in the center. His voice came out of the mask. “Hey, Dr. Austen, where’s your space suit? I thought you guys from the C.D.C. have to work in space suits.” He laughed behind his mask.
“I’ve never worn one,” she said.
They put on plastic safety glasses, to prevent blood or fluid from splashing into their eyes. Dudley didn’t need safety glasses, since he was already wearing eyeglasses.
They put on rubber surgical gloves.
Then Glenn Dudley fitted a glove made of stainless-steel chain mail over his left hand. The chain-mail glove indicated that he was going to be the prosector—the leader of the autopsy, the person who did the cutting. In the New York O.C.M.E. the prosector wears a metal glove on one hand; it is a sign of medical authority and, more important, a safety measure. Most accidental knife cuts during autopsy occur on the pathologist’s nondominant hand. In most people that’s the left hand. You hold the knife in your dominant hand, so accidental cuts usually occur on the nondominant hand. You wear a chain-mail glove on your nondominant hand.
They put on heavy yellow rubber dishwashing gloves over their surgical gloves. Dudley drew a rubber glove over his metal glove.
“The decedent is in 102,” Ben Kly said.
They followed Kly through the morgue as he wheeled an empty pan around the ring-shaped room to a stainless-steel door, crypt number 102. Inside, lying on a tray, was a white body pouch. A stale odor came out of the crypt.
“Dr. Austen, the smell doesn’t affect you?” Nathanson asked.
“It’s a little stronger than what I’m used to.”
“They do them fresh in hospitals,” Ben Kly remarked, rolling out the tray. A human form gave shape to the white pouch.
Nathanson said, “Manhattan is not like other places. People come to Manhattan to live alone. It means they often die alone. We handle a surprising number of putrefied bodies. What you are smelling is the stench of loneliness, Dr. Austen.”
Kly took the shoulders, grasping them through the pouch, while Dudley took the feet. In one expert motion they lifted up the body and transferred it to the pan. Kly wheeled it over to a floor scale and read the dial. “A hundred and eighteen pounds,” he said, writing it on a clipboard.
He pushed the gurney through a pair of doors into the autopsy room.
“Welcome to the Pit,” Kly said.
The autopsy room was seventy feet long, and was partly underground. In it stood eight stainless-steel autopsy tables, lined up in a row. This was autopsy central for Manhattan, one of the busiest autopsy rooms in the world. Four of the tables had pathologists working at them; they were in the process of laying out bodies, preparing to go to work; some had begun cutting. The Pit was a gray zone, a place neither definitely hot nor definitely safe. It was somewhere in between. An ultraviolet light on the wall shed rays into the room that were supposed to kill airborne pathogens, viruses and bacteria. On the floor, air-filtering machines hummed, cleaning the air of infective particles that might get into the lungs of the pathologists.
Ben Kly halted the pan next to an autopsy table and set the brake. He unzipped the white bag.
Kate
HER EYES WERE CLOSED
, the eyelids puffy. She had had a streaming bloody nose, and the blood had run over her chin and pooled in the hollow of her throat. Someone, probably a busy nurse, had attempted to wash her face, but the washing had not been thorough.
People are fastidious by nature, and have a hundred ways of grooming their bodies and keeping order about their persons. When a person dies, the ways of grooming vanish. The first impression one has of a dead person is of disorder—unkempt hair, purposeless limbs, blotchy moist skin with specks of dirt on it, eyes half open, a faint meaty unwashed smell.
Her teeth were visible in a grimace behind shredded lips. The teeth were stained with brownish blood. Her hair was russet, shining and beautiful, wavy hair. With a start, Austen saw that the girl’s hair was the same color and texture as her own hair. There were two rings in her left ear.
“Her name is Catherine Moran,” Nathanson said. “Our medicolegal investigator talked to some of her teachers yesterday. They called her Kate.”
Ben Kly unzipped the pouch completely. The dead girl was wearing a short hospital gown, as if for modesty.
Dudley opened the investigator’s report, a collection of sheets of paper in a manila folder.
“Case number 98-M-12698,” Dudley said, reading from the file. “She collapsed in a school classroom.” His eyes glanced rapidly over the report. “Mater School, on Seventy-ninth Street. She became extremely ill in class. Yesterday. About ten-thirty in the morning. She fell to the floor. She was grimacing and biting her lips—biting herself, chewing her lips and swallowing them—grand mal seizures—heavy nosebleed—sudden unexplained death. Yeah, and they reported she went into a hard tonic seizure at the end. Superficially, the case looks like Harmonica Man—you’ve got the wild seizures, the hard clonic tensing of the spine, the bleed, the chewing. She was D.O.A. at New York Hospital. It made the news last night.”
“You’ve got a homeless man and a young woman from a well-to-do background,” Nathanson remarked. “That in itself stands out. There’s no obvious connection between them.”
“Drugs,” Dudley said.
“It’s almost like there was a demon inside them,” Ben Kly whispered.
“Want to call in a priest, Kly?” Dudley said.
“I’m a Presbyterian,” Kly answered.
“The hospital did a blood and spinal workup?” Austen asked.
“They didn’t run any tests—she was pronounced dead,” Dudley replied.
Dudley and Kly lifted the girl out of the pouch and transferred her to the autopsy table. The inside surfaces of the pouch glistened with droplets of black blood. They stretched her out on her back, on the heavy steel mesh of the table, with water running underneath the mesh. They removed the gown. Her breasts were small. Her body was young.
The appearance of Kate’s body disturbed Austen. The truth was that the girl looked very much like her. She could be my younger sister, Austen thought, if I had a younger sister. She reached out and took the left hand of the girl in her gloved hand. She lifted the hand up gently and looked at it. The fingernails were delicate.
“Someone could have given her a hot load, Lex,” Dudley said.
Austen frowned, puzzled.
Nathanson explained, “A lethal dose of bad drugs, Dr. Austen. A hot load. Dealers do it when they want to get rid of a customer.”
“That would make it a homicide, but it would be hard to prove,” Dudley said.
Nathanson suddenly said, “Dr. Austen—I’d like you to be the prosector for this one. You can do the autopsy.”