“Actually, there are some other significant findings. First of all, it looks as though she was beaten recently. She’s got healing bruises on her arms, legs, and torso. As you may know, bruising takes place as a result of force. Small blood vessels burst and the blood pools beneath the skin. In the first day or two, the bruise would be red. After one to two days, that blood begins to lose oxygen, causing the skin to change color to black, blue or purple. Beyond that, as the body produces biliverdin and bilirubin to break down hemoglobin, the bruise turns a green or yellow. That stage takes place about five to ten days after the initial injury. At ten to fourteen days after that first bruising, you would see a yellowish-brown or light brown. She’s got bruises ranging from purple to yellow-brown all over her body.”
“If they’re in various stages of healing,” Josie said. “Then she was beaten more than once in the last two weeks.”
“I believe so,” Dr. Feist said. “The pattern of abuse here is consistent with her having been beaten more than once in recent days or weeks.”
“But you can’t say for certain?” Noah asked.
Dr. Feist frowned. “I can’t tell you with certainty how old these injuries are because bruising, as well as any injury, really, depends on a lot of factors.”
“Like what?” Noah prodded.
“This woman’s clotting factor, health factors, whether or not she was anemic. Any number of things.”
“You can’t tell those things from the autopsy?” said Noah.
“I’m afraid not. Think of it this way.” She pointed to the corner of the autopsy table. “My assistant, Ramon, and I both occasionally bump our hips into this corner. I bruise but he does not. It’s the same variation as you would see among people who fall. Children, for example. One child might take a spill off the end of a sliding board, hop up, and be just fine. Another child might have the same exact fall but sustain serious injuries. Every person is different. As you know, if I ever had to testify in court to my findings on this autopsy, I would not be able to testify with certainty as to the timing of any of these bruises.”
Noah made a noise of frustration in his throat. “But you just gave us that whole rundown of the stages of bruising.”
Dr. Feist nodded. “Yes. What I can tell you is that her injuries are consistent with her having sustained these bruises sometime in the last two weeks. Also, she has a broken rib that is only just beginning to heal, and some healing cuts inside her cheeks that are consistent with her being slapped or possibly punched in the face multiple times. Also, this cheekbone,” Dr. Feist pointed to the woman’s left cheek, “has a fracture that is beginning to heal, which leads me to believe all of the injuries were inflicted antemortem.”
“Before death?” Noah asked. “How can you tell how old they are?”
Dr. Feist waved them over to the stainless-steel countertop where her laptop sat. She pulled up a set of x-rays marked “Jane Doe.” The first one she enlarged was a rib cage. “Here,” she said, pointing to what looked like a thin vertical line cutting through one of the ribs. “See how there it looks like there’s almost a cloud around it? That’s called callus. When a bone breaks, there is a lot of inflammation and usually a blood clot forms at the site. After about a week, a callus begins to form, bridging the fracture. It’s just made up of fibrous tissue and cartilage. Sometimes it’s observable on x-rays as early as a week after the break but sometimes not. If it were an older fracture, I would expect to see more calcification. Same with the cheekbone.” She closed out the rib x-ray and pulled up one of Jane Doe’s face, repeating her findings. “In terms of the cuts inside her cheeks, there is evidence of clotting which would not happen had she been dead. I did find some cuts on her body and a few fractures which appear to have happened postmortem, probably as a result of her body being swept downriver and coming into contact with rocks and other debris.”
“The lump on her temple,” said Josie. “Can you tell how long ago that occurred?”
Dr. Feist returned to the body and pointed to Jane Doe’s head with a gloved finger. Josie was grateful that she had arranged the hair so that they could not see the saw line where the skull had been removed for examination of the brain. “Again, I can’t give you an exact time but its appearance is consistent with an injury that occurred sometime within the twenty-four hours before her death. I know it did not happen postmortem because she had to have been alive for the blood to settle here and cause the lump in the first place. Internally, she had an acute subdural hematoma which would have accounted for why she was in a weakened and probably disoriented state when you found her.”
Josie asked, “Any idea what caused it?”
“Unfortunately, no. She could have fallen or someone could have hit her with a blunt object. Often when victims are struck with an object, we see patterned injuries, meaning that the object causing the injury is sometimes reproduced on the skin. However, here there are no marks definitive enough to tell me what caused the bruising or the hematoma. That doesn’t mean she wasn’t hit with a blunt object, just that if she was, we have no way of guessing the object. However…”
Pausing, Dr. Feist stepped toward Jane Doe’s waist and carefully uncovered one of her arms. Josie immediately saw one of the significant findings Dr. Feist wanted them to note. Circling Jane Doe’s wrist were a number of ugly red and purple abrasions and in some spots, slices where something straight-edged had cut into her flesh. Angry red slashes in a bed of purple bruises. “These are very fresh,” said Dr. Feist, “but overlaid onto older ones—and when I say older, I mean only a few days or possibly a week or two.”
Noah said, “You mean they’re consistent with abrasions caused a few days or possibly a week or two ago.”
Dr. Feist smiled. “You’re getting the hang of this now.”
“She was bound,” Noah said. “What would do that? Zip ties?”
Dr. Feist nodded. “I believe so, yes.” She moved to the other side of the table and uncovered Jane Doe’s other arm which looked equally brutalized. “Clearly, she struggled to get out of them not long before she died. Otherwise, we would not see so much damage to the tissue. Some of these abrasions are quite deep. Also, if you look here—” she lifted Jane Doe’s arm so that they could see the outside of her wrist, on the pinky finger side, where long, bright red abrasions went from the zip tie marks almost to her elbow. “It looks like she tried to get them off herself by rubbing them against something. Both arms look like this.”
“Could she have tried scraping them against the boulders?” Josie asked. “She was lodged between two large boulders when we found her. If she’d been restrained, that would explain why she didn’t simply climb out.”
“Yes,” Dr. Feist said. “I was able to get some of the dirt and debris that had become embedded in her skin from these injuries. I’m sending the samples to the state police lab for analysis but knowing what I know about the area, I would not be surprised if the results came back as consistent with soil samples which Hummel will take from the river.”