“I can imagine, and of course, I’ll call as soon as I have something.”
With a grateful smile, Fletcher left to start his investigation into the congressman’s last hours. Nocek asked if she needed help. She demurred, so he went to deal with the other insanities, and she and Murphy got to work.
Leighton was the third death of the day, that was indisputable. But without more information, doing the post, seeing the other victims, Sam couldn’t say conclusively that he was a part of the attack.
So she focused on the task at hand. After her initial examination of the body’s exterior, which showed exceptional edema of the head, neck, eyelids, upper and lower extremities, frothy blood coming from the mouth and nose, and a bluish cast to the skin, Murphy did the preliminary dissection, opening Leighton’s chest with her scalpel, a wide-legged Y incision. She fed the flesh away from the breastplate and used the shears to snap the ribs, one crunch at a time, until the breastplate came clear and Sam could look into the chest cavity unhindered.
What she saw was unusual, to say the least. More frothy blood, plus all of Leighton’s organs swollen beyond proportion, especially his heart, bulging in its pericardial sac, and his lungs, so distended they engulfed the chest cavity and touched at the midpoint. She poked around a bit, trying to get the lay of the land. His spleen was visibly bloated, the liver fatty, and more edema present. She began the dissection. His enlarged heart was otherwise healthy for a man his age, with little cholesterol plaque built up in the arteries, so cardiac arrest wasn’t the culprit. She started to work on the block of lungs and quickly realized Leighton was suffering from an underlying disease. His lungs were distended and the air pockets diffusely enlarged, ravaged most certainly from a lifetime of asthma. Bronchiectasis. Which made her wonder—why hadn’t he used his inhaler? In a case of fulminant pneumonia, surely the congressman would have been sucking hard on his albuterol. And if that didn’t work...
“Hey, Murphy, you have his clothes?”
“Sure.” She pulled out the plastic bag and held it up. “What do you need?”
“Look through his pockets for an inhaler. He’s asthmatic. Just curious what he was using.”
Murphy dug in, but came up empty.
“That’s weird. I guess he could have dropped it at his office, right?”
“Sure. In the heat of the moment, absolutely. It’s not something we would grab to bring in, either. What are you thinking, Doc?”
“He’s had asthma for a long time. He definitely had an attack quite recent to his death. The airways are reddened and swollen inside. His inhaler would have started to make at least a little dent in the swelling in his bronchial tree, but I’m not seeing any evidence of that. Honestly, I’m not seeing anything that indicated he tried to arrest the attack at all.”
She went back to the body and looked him over carefully. On a man who had a normal spread of hair on his body, a needle mark could be concealed and missed on the initial examination. On skin as smooth as the congressman’s, though, an injection site should show itself easily. She couldn’t find one. He was in shape, no extra folds of fat to hide the marks. His thighs were clear, as were his buttocks, arms and stomach.
Interesting.
She thought about how the situation must have gone down. The attack would have started small. Staying calm and not hyperventilating is the key to keeping a mild asthma attack from becoming a major event. The congressman might have breathed into a paper bag, or something equally calming. But that didn’t work, so he brought out the defenses—his inhaler, maybe a nebulizer. Perhaps even popped a bit of prednisone, knowing the anti-inflammatory would help. Toxicology would tell what medications he’d taken. A witness would be of help, too, especially since the tox screen wouldn’t show the corticosteroid.
When none of the usual treatments worked, he should have called 911 and broken out his EpiPen. Jammed the lifesaving medicine into his thigh and gotten his ass to the hospital.
But he didn’t have a mark on him.
But he did have massive pulmonary edema. His lungs were yellowish and heavy, and the fluid in the chest cavity was bloody. Significant airway wall thickening showed evidence of a hyperacute pulmonary attack and fulminant pneumonia.
All signs pointed to a massive asthma attack, of that Sam was sure.
But what had triggered it? Without knowing Leighton’s schedule, without knowing if he’d been exposed this morning, she couldn’t say for sure that his death was related to the others.