“Roke it out,” he repeated. Miranda looked as baffled as I felt.
“Roking out a body is a dissection technique,” he explained. “The Rokitansky technique. Named for Karl von Rokitansky, a pathologist at the University of Vienna a century ago. During his career Rokitansky performed or supervised a hundred thousand autopsies.”
“Wow,” said Miranda. “If practice makes perfect, ol’ Karl must have been damn good. So ‘Roking her out’ is pathologist slang for what, exactly?”
“Gutting the corpse,” he said. “The way a hunter guts a deer. Pulling out all the internal organs, from the chest all the way down the abdomen, in one long string.”
“Yuck,” exclaimed Miranda, who never showed any squeamishness around decayed or dismembered human corpses.
“I’ve never Roked out a body or gutted a deer,” I said to Garcia. “You want me to go up to the hospital lobby and corral a hunter? There’s probably a guy up there who’s field-dressed dozens of deer. He might do a quicker and neater job than I can.”
“You’ll do fine,” he assured me. Following his directions, I cut the carotid artery and tied it off, then did the same with the subclavian arteries, the pipelines carrying blood to the arms. Next, trading the scalpel for the long autopsy knife—the one Jess Carter always called a “bread knife”—I sliced through the windpipe and the esophagus and tugged them downward, peeling the lungs and the heart and other organs out of the body cavity and away from the spine.
As I pulled, the cavity behind the lungs became visible. This space, too, brimmed with watery fluid.
“Interesting,” Garcia murmured again. “Pronounced effusions, but no real bleeding. I’m surprised.” He took in a deep breath and exhaled heavily. “Also concerned.”
I looked at him. “Concerned about what? Why?”
“Hemorrhage was my prime suspect, and it would have been a relatively benign explanation.”
“Not so benign for the dead woman,” Miranda pointed out.
“No, not for her, but for others,” he responded.
I paused, resting the heart and lungs on the corpse’s abdomen. I suspected I knew how he’d answer my next question, and I didn’t much like it. “So if hemorrhage didn’t kill her, what’s the next-best possibility, or the next-worst possibility—infection?”
“Not just infection. Infection leading to toxic shock.”
Miranda’s eyebrows shot up. “Toxic shock? Isn’t that what happens when a woman leaves in a tampon too long? This woman was, what, sixty? Surely she was past menopause.”
“She was,” he confirmed. “And you’re right, tampons are what most people associate with toxic shock. But there are other causes. Toxic shock can occur after normal childbirth, after spontaneous or induced abortion, after injury, after surgery. Sometimes the bacteria that create the toxins are new invaders; sometimes they’re already in the body, but at a harmless level. Then something in the body’s chemistry shifts and they start multiplying like crazy, producing spores by the billions. When they do, they can overwhelm the host within a matter of hours.”
“By ‘host’ I assume you mean the unlucky human,” said Miranda, and he nodded. “But according to the ER chart, this woman got vancomycin,” she persisted. “Isn’t that like the hydrogen bomb of antibiotics?”
“It’s powerful,” he agreed. “It can kill bacteria that are resistant to other antibiotics. But by the time she got it, it was already too late. In cases of toxic shock, it’s not the bacteria themselves that cause death. It’s the poisons they produce—the toxins—that are lethal, and antibiotics can’t destroy the toxins. Once toxic shock sets in, the mortality rate can range between fifty and one hundred percent, depending on which bacterium is involved. Some bacterial toxins are deadly; others are even deadlier.”
“Should I be running away right now?” Miranda tried to make the question sound like a joke, but she couldn’t hide the strain in her voice.
“If you want to leave, I understand,” he said. “You, too, Bill. The face shield and the mask and the gown and the double gloves are good protection, but there are no guarantees. Does either one of you have any open cuts or scrapes?” Miranda and I both shook our heads. Miranda’s eyes widened abruptly as her gaze dropped to Garcia’s left wrist and mangled right hand, both still bandaged.
“Jesus, Eddie, you’re the one who shouldn’t be here,” she said. “Your hands aren’t fully healed, and your immune system’s been compromised.”
He shrugged. “Iam at more risk here,” he acknowledged. “I thought about that yesterday, and I decided to accept the risk.”