I said I did, and then asked, “Who’s doing the post on Karen Randall?”
Alice gave a disapproving frown. “They sent someone over from the Mem. His name, I believe, is Hendricks.”
I was surprised. I had expected someone big to do this case.
“He inside?” I asked, nodding toward the end of the hall.
“Umm,” Alice said.
I walked down toward the two swinging doors, past the freezers on the right which stored the bodies, and past the neatly labeled sign: AUTHORIZED PERSONNEL ONLY BEYOND THIS POINT. The doors were wood, without windows, marked IN and OUT. I pushed through into the autopsy room. Two men were talking in a far corner.
The room was large, painted a dull, institutional green. The ceiling was low, the floor was concrete, and the pipes overhead were exposed; they don’t spend much on interior decoration here. In a neat row were five stainless-steel tables, each six feet long. They were tilted slightly and made with a lip. Water flowed constantly down the table in a thin sheet and emptied into a sink at the lower end. The water was kept running all during the autopsy, to carry away blood and bits of organic matter. The huge exhaust fan, three feet across and built into one frosted-glass window, was also kept on. So was the small chemical unit that blew scented ersatz air-freshener into the room, giving it a phony pine-woods odor.
Off to one side was a changing room where pathologists could remove their street clothes and put on surgical greens and an apron. There were four large sinks in a row, the farthest with a sign that said THIS SINK FOR WASHING HANDS ONLY. The others were used to clean instruments and specimens. Along one wall was a row of simple cabinets containing gloves, bottles for specimens, preservatives, reagents, and a camera. Unusual specimens were often photographed in place before removal.
As I entered the room, the two men looked over at me. They had been discussing a case, a body on the far table. I recognized one of the men, a resident named Gaffen. I knew him slightly. He was very clever and rather mean. The other man I did not know at all; I assumed he was Hendricks.
“Hello, John,” Gaffen said. “What brings you here?”
“Post on Karen Randall.”
“They’ll start in a minute. Want to change?”
“No, thanks,” I said. “I’ll just watch.”
Actually I would have liked to change, but it seemed like a bad idea. The only way I could be certain of preserving my observer’s role would be to remain in street clothes. The last thing I wanted to do was to be considered an active participant in the autopsy, and therefore possibly influencing the findings.
I said to Hendricks, “I don’t think we’ve met. I’m John Berry.”
“Jack Hendricks.” He smiled, but did not offer to shake hands. He was wearing gloves, and had been touching the autopsy body before them.
“I’ve just been showing Hendricks a few physical findings,” Gaffen said, nodding to the body. He stepped back so I could see. It was a young Negro girl. She had been an attractive girl before somebody put three round holes in her chest and stomach.
“Hendricks here has been spending all his time at the Mem,” Gaffen said. “He hasn’t seen much of this sort of thing. For instance, we were just discussing what these little marks might represent.”
Gaffen pointed to several flesh tears on the body. They were on the arms and lower legs.
Hendricks said, “I thought perhaps they were scratches from barbed wire.”
Gaffen smiled sadly. “Barbed wire,” he repeated.
I said nothing. I knew what they were, but I also knew that an inexperienced man would never be able to guess.
“When was she brought in?” I said.
Gaffen glanced at Hendricks, then said, “Five A.M. But the time of death seems to be around midnight.” To Hendricks he said, “Does that suggest anything?”
Hendricks shook his head and bit his lip. Gaffen was giving him the business. I would have objected but this was standard procedure. Browbeating often passes for teaching in medicine. Hendricks knew it. I knew it. Gaffen knew it.
“Where,” Gaffen said, “do you suppose she was for those five hours after death?”
“I don’t know,” Hendricks said miserably.
“Guess.”
“Lying in bed.”
“Impossible. Look at the lividity.5 She wasn’t lying flat anywhere. She was half seated, half rolled over on her side.”
Hendricks looked at the body again, then shook his head again.
“They found her in the gutter,” Gaffen said. “On Charleston Street, two blocks from the Combat Zone. In the gutter.”
“Oh.”
“So,” Gaffen said, “what would you call those marks now?”
Hendricks shook his head. I knew this could go on forever; Gaffen could play it for all it was worth. I cleared my throat and said, “Actually, Hendricks, they’re rat bites. Very characteristic: an initial puncture, and then a wedge-shaped tear.”
“Rat bites,” he said in a low voice.
“Live and learn,” Gaffen said. He checked his watch. “I have a CPC now. Good to see you again, John.” He stripped off his gloves and washed his hands, then came back to Hendricks.
Hendricks was still looking at the bullet holes and the bites.
“She was in the gutter for five hours?”
“Yes.”
“Didn’t the police find her?”
“Yes, eventually.”
“Who did it to her?”
Gaffen snorted. “You tell me. She has a history of a primary luetic oral lesion, treated at this hospital, and five episodes of hot tubes, treated at this hospital.”
“Hot tubes?”
“P.I.D.”6
“When they found her,” Gaffen said, “she had forty dollars in cash in her bra.”
He looked at Hendricks, shook his head, and left the room. When we were alone, Hendricks said to me, “I still don’t get it. Does that mean she was a prostitute?”
“Yes,” I said. “She was shot to death and lay in the gutter for five hours, being chewed by sewer rats.”
“Oh.”
“It happens,” I said. “A lot.”
The swinging door opened, and a man wheeled in a white-shrouded body. He looked at us and said, “Randall?”
“Yes,” Hendricks said.
“Which table you want?”
“The middle.”
“All right.” He moved the cart close, then swung the body over onto the stainless-steel table, shifting the head first, then the feet. It was already quite stiff. He removed the shroud quickly, folded it, and set it on the cart.
“You gotta sign,” he said to Hendricks, holding out a form.
Hendricks signed.
“I’m not very good at this,” Hendricks said to me. “This legal stuff. I’ve only done one before, and that was an industrial thing. Man hit on the head at work and killed. But nothing like this…”
I said, “How did you get chosen for this one?”
He said, “Just lucky, I guess. I heard that Weston was going to do it, but apparently not.”
“Leland Weston?”
“Yes.”
Weston was the chief pathologist of the City Hospital, a great old man and probably the best pathologist in Boston, bar none.
“Well,” Hendricks said. “We might as well get started.”
He went to the sink and began a long and thorough scrub. Pathologists who scrub for a post always annoy me. It makes them too much like parodies of surgeons: the idiotic reverse of the coin, a man dressed in a surgical uniform—baggy pants, V-neck short-sleeve blouse—cleaning his hands before operating on a patient who was past caring whether he received sterile treatment or not.
But in Hendricks’ case, I knew he was just stalling.
AUTOPSIES ARE NEVER VERY PRETTY. They are particularly depressing when the deceased is as young and as attractive as Karen Randall was. She lay nude on her back, her blonde hair streaming down in the water. Her clear blue eyes stared up
at the ceiling. While Hendricks finished scrubbing, I looked at the body and touched the skin. It was cold and smooth, the color gray-white. Just what you’d expect for a girl who had bled to death.
Hendricks checked to see that there was film in the camera, then waved me aside while he took three pictures from different angles.
I said, “Have you got her chart?”
“No. The old man has that. All I’ve got is a summary of the OPD discharge.”
“Which was?”
“Clinical diagnosis of death secondary to vaginal hemorrhage complicated by systemic anaphylaxis.”
“Systemic anaphylaxis? Why?”
“Beats me,” Hendricks said. “Something happened in the OPD, but I couldn’t find out.”
“That’s interesting,” I said.
Hendricks finished with his pictures and went to the blackboard. Most labs have a blackboard, on which the pathologist can write his findings as he makes them—surface markings of the body, weight and appearance of organs, that sort of thing. He went to the board and wrote, “Randall, K.” and the case number.
At that moment, another man entered the room. I recognized the bald, stooping figure of Leland Weston. He was in his sixties, about to retire, and despite his stoop he had a kind of energy and vigorousness. He shook hands with me briskly, then with Hendricks, who seemed very relieved to see him.
Weston took over the autopsy himself. He began, as I remembered he always did, by walking around the body a half-dozen times, staring at it intently, and muttering to himself. Finally he stopped and glanced at me.
“Observed her, John?”
“Yes.”
“What do you make of it?”
“Recent weight gain,” I said. “There are striation marks on her hips and breasts. She is also overweight.”
“Good,” Weston said. “Anything else?”
“Yes,” I said. “She has an interesting hair distribution. She has blond hair, but there is a thin line of dark hair on her upper lip, and some more on her forearms. It looks sparse and fine to me, new looking.”
“Good,” Weston said, nodding. He gave me a slight, crooked grin, the grin of my old teacher. For that matter, Weston had trained most of the pathologists in Boston at one time or another. “But,” he said, “you’ve missed the most important finding.”
He pointed to the pubic area, which was cleanly shaven. “That,” he said.
“But she’s had an abortion,” Hendricks said. “We all know that.”
“Nobody,” Weston said sternly, “knows anything until the post is completed. We can’t afford to prediagnose.” He smiled. “That is a recreation reserved for the clinicians.” He pulled on a pair of gloves and said, “This autopsy report is going to be the best and most accurate we can make. Because J. D. Randall will be going over it with a fine comb. Now then.” He examined the pubic area closely. “The differential of a shaved groin is difficult. It may imply an operation, but many patients do it for purely personal reasons. In this case, we might note that it was carefully done, with no nicks or small cuts at all. That is significant: there isn’t a nurse in the world who can do a pre-op shave on a fleshy region like this without making at least one small slip. Nurses are in a hurry and small cuts don’t matter. So…”
“She shaved herself,” Hendricks said.
“Probably,” Weston nodded. “Of course, that doesn’t rule in or out an operation. But it should be kept in mind.”
He proceeded with the autopsy, working smoothly and quickly. He measured the girl at five-four and weighed her at one-forty. Considering the fluid she had lost, that was pretty heavy. Weston wrote it on the blackboard and made his first cut.
The standard autopsy incision is a Y-shaped cut running down from each shoulder, meeting at the midline of the body at the bottom of the ribs, and then continuing as a single incision to the pubic bone. The skin and muscle is then peeled away in three flaps; the ribs are cut open, exposing the lungs and heart; the abdomen is widely incised. Then the carotid arteries are tied and cut, the colon is tied and cut, the trachea and pharynx are cut—and the entire viscera, heart, lungs, stomach, liver, spleen, kidneys, and intestine are removed in a single motion.
After that, the eviscerated body is sewn shut. The isolated organs can then be examined at leisure, and sections cut for microscopic examination. While the pathologist is doing this, the deaner cuts the scalp open, removes the skullcap, and takes out the brain if permission for brain removal has been obtained.
Then I realized: there was no deaner here.7 I mentioned this to Weston.
“That’s right,” he said. “We’re doing this one by ourselves. Completely.”
I watched as Weston made his cut. His hands trembled slightly, but his touch was still remarkably swift and efficient. As he opened the abdomen, blood welled out.
“Quick,” he said. “Suction.”
Hendricks brought a bottle attached to a suction hose. The abdominal fluid—dark red-black, mostly blood—was removed and measured in the bottle. Altogether, nearly three liters were withdrawn.
“I wish we had the chart,” Weston said. “I’d like to know how many units they gave her in the EW.”
I nodded. The normal blood volume in an average person was only about five quarts. To have so much in the abdomen implied a perforation somewhere.
When the fluid was drained, Weston continued the dissection, removing the organs and placing them in a stainless-steel pan. He carried them to the sink and washed them, then examined them one by one, beginning at the top, with the thyroid.
“Peculiar,” he said, holding it in his hands. “It feels like fifteen grams or so.”
The normal thyroid weighed between twenty and thirty.
“But probably a normal variation,” Weston said. He cut it open and examined the cut surface. We could see nothing unusual.
Then he incised the trachea, opening it down to the bifurcation into the lungs, which were expanded and pale white, instead of their normal pink-purple.
“Anaphylaxis,” Weston said. “Systemic. Any idea what she was hypersensitive to?”
“No,” I said.
Hendricks was taking notes. Weston deftly followed the bronchi down into the lungs, then opened the pulmonary arteries and veins.
He moved on to the heart, which he opened by making two looping incisions into the right and left sides, exposing all four chambers. “Perfectly normal.” Then he opened the coronary arteries. They were normal too, patent with little atherosclerosis.
Everything else was normal until we got to the uterus. It was purplish with hemorrhagic blood, and not very large, about the size and shape of a light bulb, with the ovaries and fallopian tubes leading into it. As Weston turned it in his hands, we saw the slice through the endometrium and muscle. That explained the bleeding into the peritoneal cavity.
But I was bothered by the size. It just didn’t look like a pregnant uterus to me, particularly if the girl was four months’ pregnant. At four months, the fetus was six inches long, with a pumping heart, developing eyes and face, and forming bones. The uterus would be markedly enlarged.
Weston thought the same thing. “Of course,” he said, “she probably got some oxytocin8 at the EW, but still, it’s damned peculiar.”
He cut through the uterine wall and opened it up. The inside had been scraped quite well and carefully; the perforation was obviously a late development. Now, the inside of the uterus was filled with blood and numerous translucent, yellowish clots.
“Chicken-fat clots,”9 Weston said. That meant it was postmortem.
He cleaned away the blood and clots and examined the scraped endometrial surface carefully.
“This wasn’t done by a total amateur,” Weston said. “Somebody knew at least the basic principles of curettage.”
“Except for the perforation.”
“Yes,” he said. “Except for that.”
“Well,” he said, “at least we already know one thing. She didn’t do it to herself.??
?
That was an important point. A large proportion of acute vaginal hemorrhages are the result of women attempting self-abortion, with drugs, or salt solutions, or soaps, or knitting needles and other devices. But Karen couldn’t have done this kind of scraping on herself. This required a general anesthetic for the patient.
I said, “Does this look like a pregnant uterus to you?”
“Questionable,” Weston said. “Very questionable. Let’s check the ovaries.”
Weston incised the ovaries, looking for the corpus luteum, the yellow spot that persists after the ovum has been released. He didn’t find one. In itself, that proved nothing; the corpus luteum began to degenerate after three months, and this girl was supposedly in her fourth month.
The deaner came in and said to Weston, “Shall I close up now?”
“Yes,” Weston said. “You might as well.”
The deaner began to suture the incision and wrap the body in a clean shroud. I turned to Weston. “Aren’t you going to examine the brain?”
“No permission,” Weston said.
The medical examiner, though he demanded an autopsy, usually did not insist on brain examination unless the situation suggested possible neuropathy.
“But I would have thought a family like the Randalls, medically oriented…”
“Oh, J. D. is all for it. It’s Mrs. Randall. She just refuses to have the brain removed, absolutely refuses. Ever met her?”
I shook my head.
“Quite a woman,” Weston said dryly.
He turned back to the organs, working down the GI tract from esophagus to anus. It was completely normal. I left before he finished everything; I had seen what I wanted to see and knew that the final report would be equivocal. At least on the basis of the gross organs, they would be unable to say that Karen Randall was definitely pregnant.
That was peculiar.
Position as an intern or resident, where one is an M.D. but not licensed to practice, and still completing education.
Formerly the most violent area in Boston was Scollay Square, but it was demolished five years ago to make way for government buildings. Some consider that an improvement; some a step backward.