The Bone Bed

twenty-one

AROUND THE CFC, FORENSIC DENTIST NED ADAMS IS known as the tooth whisperer because of what the dead confide in him. Age, economic status, hygiene, and if that’s not enough to tattle about, teeth snitch on diet, drink, drugs, and if the person were pregnant or had acne or an eating disorder.

In his late sixties, slightly stooped, with bad knees and a deeply wrinkled face that has smiled more than frowned, Ned can determine minutiae from a single tooth that the deceased’s closest friends and family likely never knew or imagined. Peggy Lynn Stanton, he confirms, as we wheel her body along the corridor after weighing and measuring it in the receiving area, was victimized in life by a very bad dentist, who, as Ned puts it, cost her or someone “an arm and a leg.”

A Dr. Pulling; now, how’s that for a name? Only he sure didn’t live up to it in her case, as I’m about to tell you.” Ned stiffly accompanies Luke and me toward the decomp cooler, his raincoat draped over his arm, a buoyant air about him, because his mission is successfully accomplished and he’s in no hurry to go home to an empty house. “Some cosmetic dentist in Palm Beach, Florida, who didn’t comply with the standard of care; not saying it was intentional. Maybe just incompetence.”

Yeah, right,” Luke says sarcastically. “Where’s the loot?”

Tooth number eight, a maxillary central incisor with extensive internal root resorption coupled with a buccal fistula,” Ned says. “You can’t miss this big internal radiolucency in the middle of the pulp canal in her pre- and postmortem radiographs.”

This is under a crown?” I pull up the handle of the cooler door.

Exactly. Trauma resulting in an infection and ongoing inflammation that went unchecked, and he slapped a porcelain crown on top of it anyway. I’m guessing this joker cost her about forty-K, all told, and a lot of pain and inconvenience. Her bite’s messed up, I’m pretty sure, but can’t prove it because I can’t exactly ask her if she suffered chronic headaches. I wouldn’t be surprised if she had TMJ, though. When you go to search her house, look for a night guard.”

As if that’s the most important thing I might find.

The time frame for when the infection started?” I guide the gurney through frigid air stale with death, pushing past a silent sad audience of black-pouched mounds on steel trays, many of the patients stored here still unidentified.

It’s hard to pinpoint, but based on her charts?” Ned’s breath fogs out. “I’d say it’s related to a root canal two and a half years ago, which was followed by the porcelain crown this past March.”

So she was in Palm Beach as recently as March,” I assume, as we exit through the rear cooler door that opens onto the decomp room.

She must have been.” Ned follows us in. “And it’s impossible for me to believe that by then the resorption hadn’t already progressed to involve the periodontal ligament space and the tooth. In other words, that damn tooth should have been extracted and not restored.”

Yet one more crook in the world,” Luke says.

Well, had she lived, she inevitably would have faced an extraction followed by an implant and another crown.” Ned sets his black bag on a countertop and drapes his coat over a chair as if he plans to stay for a while. “Lots of root canals—eight, to be exact—likely from trauma caused by drilling down healthy teeth for crowns that I doubt she needed. Her rear molars, for example? Why bother putting porcelain on teeth no one’s going to see? Use gold. Believe it or not, it’s cheaper.”

Money, money, money.” Luke hands me a mask and gloves, his blue eyes calmly on mine, as if he can explain everything that’s happened, as if I should have no reason to be concerned about him.

That and this same dentist was also doing facial injections,” Ned lets us know, as Luke and I put on shoe covers and gowns. “The newest trend that I have serious qualms about? Dentists injecting patients with Perlane, Restylane, Juvéderm, and other facial fillers, and also Botox. Maybe I’m just old-fashioned, but I don’t think dentists should be plumping up cheeks and smoothing out frown lines.”

We slide the body from the gurney to an autopsy table, and she looks tragically small and wizened on cold stainless steel. Turning on an examination light, I move it along its overhead track as Luke labels specimen containers on a cart, and my feelings about him are mixed and confusing. They’re ambivalent and scary, and I try not to think about the outrageous accusations Marino made in the car this morning. I don’t want to admit they might have merit.

So this Dr. Pulling, who saw her in March, also injected her with fillers or Botox during that appointment?” I direct six thousand foot-candles of light at the anterior upper arms.

Lip augmentation. One CC of Restylane,” Ned says. “It’s in her chart. At least the guy kept pretty good records.”

Four small contusions.” I direct Luke’s attention to them. “With another one here.”

A thumb bruise?” He reaches for the light’s handle, his arm lightly touching me.

Possibly. On the opposite side. Very possibly a thumb bruise. Yes.” I show him, and he leans against me.

Fingertip bruises from gripping her,” he describes. “Gripping her upper arm, four fingers there and the thumb here.”

Thank you, Ned.” It’s my way of letting him know I’ve got what I need.

At least it’s not one of these situations that I see all too often.” He picks up his black medical bag, worn and scuffed, a wedding gift from his wife, who’s dead. “All sorts of things charted that were never done so the dentist could submit claims to the insurance company or disguise noncovered services as those that are covered. Not to mention just plain shoddy work.”

It’s really difficult to see, in her condition.” Luke uses a hand lens to examine the subtle contusions I’ve pointed out, and I’m aware of the whisper of his white gown moving as he moves, the intense light shining on his pale blond hair.

It helps to illuminate areas at different angles, getting an overview before doing a close visual exam of a particular feature or features,” I suggest to him, as I feel the heat of him and the heat of the lamp. “The same way you enter a crime scene. The big picture first. Then narrow it down. Don’t fixate so much on one thing that you miss all of it.”

I certainly wouldn’t want to be so fixated I miss all of it.” Luke adjusts the light again.

Had a case not all that long ago that I was called in to consult on.” Ned collects his raincoat from the chair. “In New Hampshire, several patients with broken dental tools in their teeth.”

Thanks so much, Ned.” I look up at him. “You saved the day, as always, and I’m grateful, the FBI is grateful, everybody’s grateful.”

He lingers by the door. “That particular dentist is up to his eyeballs in more than a hundred civil malpractice suits.”

Benton ran out to pick up pizza, and I’m guessing he’s back by now,” I let Ned know.

He’ll probably be going to prison for a few years and could be deported back to Iran.”

Maybe check on the seventh floor?” I suggest. “I’m sure they’d love your company, if you’re not in a hurry to get home.”

Maybe a few here as well?” Luke points out more brown spots, small and almost perfectly round, his arm touching mine, and I feel its firmness through the Tyvek sleeve. “If a grip was intermittent? Like we see when someone is being forcibly held, and the grip tightens and relaxes, tightens and relaxes. Would you expect fingertip bruises through her layers of clothing?”

I pick up a camera and the six-inch scale Marino labeled earlier today.

Would you expect her to bruise like this through a blouse and a wool jacket?” Luke asks, and I begin to take photographs, because Marino isn’t here.

While I don’t know exactly what is happening, I’ve gathered he’s still upstairs, being questioned by Machado and the FBI, their interest related to Twitter, to the woman Lucy told me about. Someone Marino met on the Internet and recently unfollowed in more ways than one, my niece said early this morning, when she informed me that he’d been sleeping over at the CFC on an AeroBed.

Twat was the crude word Marino used while we were driving to the Coast Guard base, and whatever foolishness he got involved in, it’s simply not possible he recently was tweeting Pretty Please, or whatever name Peggy Lynn Stanton went by on the Internet. Marino may have been tweeting someone with that handle days and weeks ago, but it wasn’t this lady on the autopsy table. She was dead long before he began tweeting whoever he assumed she was, dead before he even got his Twitter account, possibly dead and in cold storage since the spring, and my mind sorts through information nonstop, my blood pounding.

My thoughts race to connections and possibilities, my pulse rushing hard. I try to distract myself from what I’m feeling as Luke touches me, as he brushes against me and I don’t stop it.

I really didn’t mean to step over you,” he says, now that Ned is gone. “I sincerely apologize. I thought I was helping.”

I incise the brownish marks on the upper right arm to see if they are well defined beneath the epidermis. I look for staining left by hemorrhage that extends into the dermis or the deeper layer of the skin, and it does.

The question, of course, is when she might have gotten these bruises.” I grab the lamp by its handle, shining it down her arms to the shriveled tips of her fingers, with their chipped polished nails that are clipped to the quick.

I check the undersides of her wrists and the tops of her hands.

It’s very difficult, if not impossible, to age these contusions, because of her condition,” I add.

The light paints over the leathery upper chest, the wasted breasts, illuminating the wrinkled abdomen.

But depending on the degree of force used by the person gripping her, she could have been bruised through layers of clothing,” I answer Luke’s question.

Important to know if she was clothed or not, it seems to me,” he says. “I realize this is more Benton’s department. I’m not a profiler.”

The FBI can be very persuasive.” I illuminate her hips, her upper thighs. “And I’m sure they were all the more convincing to you because Benton showed up with them. But we don’t work for law enforcement, Luke.”

Of course not.”

It’s our duty to objectively answer questions raised by the evidence.” I direct the light at her knees. “And we must vigorously adhere to chain of custody, meaning we don’t open up our evidence room for the FBI or allow them to whip us into a frenzy of activity, no matter their reason or sense of urgency.”

He’s your husband, so I assumed—”

Assumed that our being married changes how he does his job or how I do mine?”

I apologize,” Luke says again. “But after his annoyance when we were in Vienna . . .”

He doesn’t finish. He doesn’t need to spell out that the last thing he’d want to do after Benton’s blatant display of jealousy last week is to anger him further. Luke knows he can. He knows why he can, and I’m not going to discuss my marriage with him or the truth about why he might be a threat to Benton.

I’m not about to openly admit to Luke Zenner that my husband and I have had our share of friction of late, episodes of uncertainty and distrust that aren’t as baseless and irrational as I’ve let on. If what we’ve fought about was truly groundless, Luke and I wouldn’t be dancing this dance of touching, of leaning, of lingering, of speaking the subtle language of heated attraction, and it’s only when it happens that I’m honest with myself.

What I can’t help but wonder is if she might have been stripped of her clothing at some point,” Luke says, as I reposition the plastic ruler, the scale, for each photograph I take. “I offer that only because the contusions look quite distinct. Here and here.”

He moves closer, his forearm touching mine, his shoulder brushing against me as he bends into what he’s examining, and I don’t want to feel what I’m feeling.

You can see where it appears someone’s fingertips pressed with considerable force, and I’m wondering if there were layers of fabric in the way.”

He leans forward, leans into me and stays there.

Would the contusions look exactly like this, were that the case?” he asks.

We can’t know for a fact whether she was bruised through clothing or not,” I reply.

Would it be worthwhile to try the ALS?” He indicates the alternate light source still on the countertop, where Marino plugged it in hours earlier.

It’s not going to help.”

So that’s a no.” He meets my eyes.

If you want to scan her in the very off chance you might visualize any faint or nonvisible bruises we’re missing, assuming we’re missing any brown patterns that are contusions?” I offer in a way that discourages him, because I must.

It’s probably ridiculous.”

It’s not ridiculous, just illogical,” I reply.

I agree. I mean, what are the chances?” he says.

The chances of finding the usual evidence the ALS can be most helpful with are next to none.” But that’s really not what I’m discouraging him from, and it’s not really what we’re talking about.

I won’t have an affair with him unless I decide I don’t care if I completely destroy my life. It’s not about whether he has a chance with me but about how crazy it is that I’m even thinking these thoughts.

Body fluids, fibers, gunshot residue, latent prints, deep tissue bruises?” I’m still talking about the ALS and what it might find under different circumstances, and I’m letting him know I understand what it’s like to want what you can’t have.

Right. Forget it,” he agrees.

That’s what I recommend. Not that I don’t understand being tempted to try.”

She’s been in the water,” he says. “A waste of time.”

And then it has to be explained,” I add. “Everything we do has to be explained.”

Should I unplug it?” He reaches for the ALS power cord.

Please,” I reply. “I’m really not interested in putting on goggles and spending an hour scanning the body from head to toe with the Crime-lite just so I can say we did. It might be worth going over her clothing, but that can wait.”

We don’t know if she had on the clothing when she got these bruises.” Luke returns to that thought as he returns to the table. “Knowing whether she was dressed or not when someone grabbed her upper arms would be an important fact, wouldn’t it? Stripping a prisoner is more about submission than anything else, isn’t it?”

Depends on who is doing it to whom and why.”

The logic of torture, a terrible thing to consider, but there is a logic to it. Humiliation, intimidation, controlling your prisoner by stripping him, hooding him. Or her,” he says. “I’m assuming she could have been bound at some point with some type of ligature that was soft and wouldn’t necessarily leave marks on her skin.”

It’s possible.”

I imagine him coming up behind her like this.” He holds up his hands to grip imaginary arms, orienting his fingertips and thumbs the way they would be if he grabbed someone by the upper arms from behind. “Maybe to forcibly move her from one place to another, such as if he forced her into a room or dragged her, were she unconscious. Or if she were tied up in a chair and he’s trying to make her give him information so he could steal her identity, for example. Her PIN, her passwords.”

I shine the lamp down her lower legs, brightly illuminating the tops and sides of her ankles and feet, and I find more brownish marks, only these are darker and drier and indistinct in their shape. Picking up the scalpel to make small incisions, I find the darkened areas of skin have lost elasticity, are extremely hard, with no evidence of hemorrhage to the underlying tissue. Not contusions but patterns caused by something else, and I find more of them on the tops of her bare feet and areas of her ankles.

We pull her on her side so I can check her back, and there are two more indistinct hard brown areas on the underside of her right elbow and forearm.

I’ve got no idea,” I puzzle. “Absolutely none.”

Some type of postmortem artifact?”

Unlike any I’ve ever seen before.” I excise a small section of the hard brown skin for histology. “It’s like cutting through stiff leather. I can’t imagine what might cause that, swaths of skin as much as four by three inches.”

Like freezer burn, perhaps?”

No. She’d have it all over if she was in a freezer and it caused that.”

But what about if certain parts of the body came in contact with metal inside a freezer?” he suggests.

Then the skin would stick.”

I insert the tip of the scalpel blade into leathery flesh just below the left sternum and incise down and to the right, and then do the same on the left and cut straight down to the navel, detouring around it to the pubic bone. It’s like making a Y-incision in wet slippery leather, and I reflect back tissue, cutting through ribs, removing the breastplate of them. I make an incision beneath the jaw to remove the neck organs and tongue.

Her hyoid’s intact.” I make notes on a body diagram as I work, the odor of decomposition overpowering now. “No sign of injury to the strap muscles, to soft tissue. No airway obstruction or aroma of chemical asphyxia, such as due to cyanide. No injury to the tongue.”

Luke peels back the scalp, and the air vibrates with the loud whining and grinding of the oscillating saw, and bone dust is suspended in the bright white light. I open the major blood vessels, the inferior vena cava, the aorta, finding what I expect, that they are empty, with dry diffuse hemolytic staining. I see no evidence of blockage or injury or disease, just a moderate amount of calcification, certainly not enough to kill her.

The brain’s too soft to section,” Luke reports. “But I’m not seeing anything to suggest cerebral injury. Dura’s intact and free of staining.” He writes it down.

Her organs are decomposed. Her lungs are collapsed, reddish-purple and very soft, the airways devoid of water, froth, sand, or foreign material, the gallbladder dry and wrinkled, with no residual bile. With each minute we work it becomes abundantly clear that this is an autopsy of exclusion, of ruling out possible causes of death and leaving little doubt that she either asphyxiated or was poisoned. But it will be a while—days, at least—before we have a complete ethanol and drug screen of liver tissue.

No petechiae I can find.” Luke opens each eye. “No irregular areas of hemorrhage to the sclera or the conjunctiva. Of course, that doesn’t rule out asphyxia by smothering or strangulation,” he adds, and he’s right.

While there are no abrasions or contusions, no injuries I might associate with smothering or strangulation, the absence of facial or scleral pinpoint hemorrhages called petechiae doesn’t mean that someone didn’t place a plastic bag over her head or tie a gag around her nose and mouth or ram a cloth down her throat that obstructed her breathing.

Her gastric contents are granular and dry like animal feed. I adjust the light and use a lens, moving the material around with forceps.

Dried out, desiccated meat,” I observe. “If I can see it grossly, it wasn’t very digested when she died.”

There’s very little in her small intestine,” Luke lets me know. “Almost nothing in her large intestine. It usually takes what? A good ten hours for food to completely clear?”

It depends on a lot of things. How much she ate, whether she exercised, her hydration. Digestion varies considerably with individuals.”

So if she ate and the food hardly had begun to digest before she died,” he supposes, “chances are we’re talking only a couple of hours after her last meal?”

Maybe. Maybe not.”

I tell him to weigh the gastric contents and place some of it in formalin so we can process it histologically.

An iodine test for starch, napthol for sugar, Oil Red O for lipids. Hopefully we can pick out identifiable food particles on the stereomicroscope.” I explain the special stains I’ll want used.

We are working side by side, our backs to the door.

So I’m going to make evidence rounds to tox, to histology, to trace, with special instructions,” Luke goes down the list. “What about SEM?”

Maybe for botanicals.” I’m vaguely aware of a shift in the air behind me. “For stomatal comparisons. For example, is it napa cabbage? Is it Chinese broccoli? Is it bok choy? Is there any evidence of arthropods such as shrimp? Are there cellular structures that might be oats? Are there cereal grains that might be wheat?”

Luke turns around, and then I do.

I’m wondering how much longer,” Benton says, from the open door he holds.

Didn’t hear you come in,” Luke replies, as if making a point.

We’re actually finishing up now.” I meet Benton’s eyes, and his are wary.

Find anything helpful?” He stands in the doorway.

The long answer is undetermined for now, pending toxicology and further studies.” I untie my gown in back. “The short answer is I don’t know.”

Not even a guess?” Benton stares at what’s on the table, and the reason he doesn’t come closer isn’t because of the odor or the ugliness.

He isn’t bothered by such things. He’s bothered by something else.

I’m not going to guess about what killed her.” I toss my gloves and shoe covers into a biohazard can. “But I can give you a long list of what didn’t.”