“Drop your scrubs in the bin on your way out,” said Dowson with sarcastic satisfaction.
Pendergast watched the cop leave. Then he turned to Dowson. “I suggest you turn the body over before making your Y-incision.”
“And why is that?”
Pendergast nodded toward the clipboard. “Page two.”
Dowson picked it up, flipped over the top page. Extensive lacerations… deep knife wounds… Looked like the girl had been stabbed repeatedly in the lower back. Or worse. As usual, it was hard to make out from the police report what had actually taken place, from a medical standpoint. There had been no investigating ME. It had been given a low priority. This Doreen Hollander didn’t count for much, it seemed.
Dowson returned the clipboard. “Sue, help me turn her over.”
They turned the body, exposing the back. The nurse gasped and stepped away.
Dowson stared in surprise. “Looks like she died on the operating table, in the middle of an operation to remove a spinal tumor.” Had they screwed up again downstairs? Just last week—twice—they had sent him the wrong paperwork with the wrong corpse. But immediately Dowson realized this was no hospital stiff. Not with dirt and leaves sticking to the raw wound that covered the entire lower back and sacrum area.
This was weird. Seriously weird.
He peered closer and began describing the wound for the benefit of the camera, trying to keep the surprise out of his voice.
“Superficially, this does not resemble the random knife slashing, stabbing, or cutting described in the report. It has the appearance of—of a dissection. The incision—if it is one—begins about ten inches below the scapula and seven inches above the belt line. It appears as if the entire cauda equina has been dissected out, starting at L1 and terminating at the sacrum.”
At this, the FBI agent looked at him abruptly.
“The dissection includes the filum terminale.” Dowson bent closer. “Nurse, sponge along here.”
The nurse removed some of the debris around the wound. The room had fallen silent except for the whirr of the camera, and there was a clattering sound as twigs and leaves slid into the table’s drainage channel.
“The spinal cord—more precisely, the cauda equina—is missing. It has been removed. The dissection extends peripherally to the neuroforamen and out to the transverse processes. Nurse, irrigate L1 to L5.”
The nurse quickly irrigated the requested area.
“The, er, dissection has stripped off the skin, the subcutaneous tissue, and paraspinous musculature. It appears as if a self-retaining retractor was used. I can see the marks of it here, and here, and here.” He carefully indicated the areas for the benefit of the video.
“The spinous processes and laminae have been removed, along with the ligamentum flavum. The dura is still present. There is a longitudinal incision in the dura from L1 to the sacrum, allowing full removal of the cord. It has the appearance of a… of a very professional incision. Nurse, the stereozoom.”
The nurse rolled over a large microscope. Quickly, Dowson inspected the spinous processes. “It looks as if a rongeur has been used to remove the processes and laminae from the dura.”
He straightened up, running a gowned arm across his forehead. This was not a standard dissection one would do in medical school. It was more like the kind of thing neurosurgeons practiced in advanced neuroanatomy classes. Then he remembered the FBI agent, Pendergast. He glanced at him, to see how he was taking it. He had seen a lot of shocked people at autopsies, but nothing like this: the man looked, not shocked exactly, so much as grim Death himself.
The man spoke. “Doctor, may I interrupt with a few questions?”
Dowson nodded.
“Was this dissection the cause of death?”
This was a new thought to Dowson. He shuddered. “If the subject were alive when this was done, yes, it would have caused death.”
“At what point?”
“As soon as the incision was made in the dura, the cerebrospinal fluid would have drained. That alone would have been enough to cause death.” He examined the wound again. It looked as if the operation had caused a great deal of bleeding from the epidural veins, and some of them had retracted—an indication of live trauma. Yet the dissector had not worked around the veins, as a surgeon on a live patient would have done, but had cut right through them. The operation, while done with great skill, had also apparently been done with haste. “A large number of veins have been cut, and only the largest—whose bleeding would have interfered with the work—have been ligated. The subject might have bled to death before the opening of the dura, depending on how fast the, er, person worked.”
“But was the subject alive when the operation began?”
“It seems she was.” Dowson swallowed weakly. “However, it seems no effort was made to keep the subject alive while the, ah, dissection was progressing.”
“I would suggest some blood and tissue work to see if the subject had been tranquilized.”