“Do you think you might want to take up surgery?”
Elise didn’t have to think about her answer. “I’m more comfortable on the other end of things, working with the patients directly. I like the challenge of . . . figuring out what’s really wrong. Diagnosis.”
Anna said, “That was the impression I had, so I’m wondering if you might find it interesting to read these postmortem reports I’ve been looking at.” She put her hand on the folder.
Elise’s whole posture changed. “I’ve never seen a postmortem.”
“That’s why I thought you might be interested.” She gestured to a chair. “Sit down, let me explain.”
? ? ?
ELISE TOOK AN hour to read through the reports, and then she sat looking out the window for a good while. The day hadn’t yet begun to wane, though it was already eight. People were drawn outdoors by the light and the fine weather, the silky touch of a warm breeze.
Somewhere in the city was a man who had caused the deaths of at least five women and maybe as many as eight, without anyone taking notice. He went about his business without interference because he showed an unremarkable face to the world. Unless he walked down the street with a bloody knife in his hand, he could go on just as he had started: an apple that looked solid until you bit into it to find your mouth full of worms.
She turned to look across the room. Anna was sitting in the corner of a sofa, her cheek against her hand while she read. She sensed Elise looking at her, and met her eye.
“Thoughts?”
“A few observations, but I doubt they’re significant.”
“Go on. Don’t leave anything out.”
This felt like a recitation in the lecture hall. Elise organized her thoughts and started.
“This doctor—I think he must be a doctor, given some of these details—started to perform these operations with two goals in mind. He wanted the patient to die in terrible pain, but he wanted the death itself to take place out of his sight.
“With Mrs. Campbell he was too violent, and with Mrs. Liljestr?m he was so fast that he damaged an artery and she hemorrhaged immediately and bled to death. So neither case satisfied him. But in the third, fourth, and fifth cases he had settled on a procedure that gave him the result he wanted, and then he was exacting. The incisions are all in the fundus between the uterine horns and spaced evenly, like tick marks on a tally sheet: one, two, three. All of them are angled to cut into the intestines to a depth of about two inches. The instrument was not sterilized, and it might even have been purposefully contaminated. That seems likely, given how quickly the infection took hold and spread.”
She looked up from the report in front of her. “Shall I go on? I have just a few more thoughts.”
Anna said, “It’s useful to hear someone else’s interpretation, so please do.”
“I was thinking of how a patient is prepared for surgery of this kind. If these women had marks on their arms and legs that indicated they had been forcibly restrained, would Dr. Lambert have noted that?”
Anna’s brows rose sharply. “Why do you ask?”
“Because if there were no restraints, he must have used anesthesia. The natural impulse would be to twist away from the pain. I’ll tell you what I think probably happened.”
She got up and walked back and forth for a moment to gather her thoughts.
“I think this person must be someone who is very well established. Or at least, has that appearance. He presents himself as a highly educated medical authority, with broad experience. He won’t be very young, and his fees will be exorbitant. Do you happen to know—”
“Yes, the fees were very high, between two hundred and three hundred dollars.”
It took a moment for Elise to make sense of such a large number.
“So these women would expect someone with a professional demeanor,” she went on, more slowly. “Someone severe, and a little frightening, but not unkind. I’m not being clear. Do you know what I mean?”
“The strict but benevolent father,” Anna said.
Elise was feeling a little more comfortable now, and she let the story come out in the way she imagined it.
“The patients will have high expectations. He must have some kind of medical office or clinic, treatment and operating rooms and the right equipment, everything in good working order and well maintained. A pleasant waiting room, and there must be an assistant or nurse, certainly. Someone to help the patients undress and dress again, and someone—maybe the same person?—to administer anesthesia.