Chapter 21

Anya walked over to the table, flipped on the hanging light above the body, and then gently turned the sheet down, folding it across April Carlson's shoulders.

"Wow," Noah said.

On the exam table, under fluorescent lights, April looked twice as disturbing as when Josie had seen her. Sallow, gaunt cheeks. Teeth that seemed to be trying to climb out of her mouth. Bruised circles under her eyes. Hacked hair, showing pieces of her scalp. Her collarbones looked ready to poke right through her delicate skin.

Anya winced. "Yeah. Sometimes gory is easier to take, especially if you know the person went quickly. This woman—she was dying long before she was stabbed."

"She was tortured?" asked Josie.

Anya nodded. "Deprivation is a form of torture, yes, although her cause of death is a penetrating stab wound to her small bowel. As you know, the weapon was retained. Hummel was here earlier to take it into custody. He's going to try to get prints and DNA from the handle. It wasn't a knife though."

Josie tried to think of a weapon with a handle similar to that of a knife that could stab through human skin and sinew to its hilt, but came up blank. "What the hell was it?"

Anya beckoned them back toward the laptop. With a few clicks, April's smiling face disappeared and a series of photos replaced it. "It was an awl."

Noah's arm brushed Josie's as he leaned in to study the pictures. Now that April's hand wasn't wrapped around it, Josie could see that the handle didn't look as close to that of a knife at all. In fact, it was shorter and rounded, similar to the shape of a light bulb. The blade was not a blade but a spear, no thicker than a pen with a sharp, pointed end.

Anya reached past them and enlarged one of the photos. She pointed to the bloodied shaft. "This part is made of steel. Three and a half inches."

It explained why Mira's wounds had been mostly punctures and gouges. Josie said, "I know that an awl is a tool, but what is it used for?"

Noah said, "The most simplistic answer is that awls are used to poke holes. I've seen guys use them in woodworking projects. They use the point to make a hole where they want to drill. I'm pretty sure they're also used in upholstery repair and for stitching leather—anything where you have heavyweight fabric or material that standard sewing implements won't penetrate. There are different kinds, different sizes."

Anya led them back to April Carlson. "I had to look it up. They're also used in shoe repair and bookbinding. Lots and lots of uses for them, and unfortunately, they're effective murder weapons. I've seen a lot in this job, but this is my first awl. No hesitation marks. Given the injuries inside her small bowel, it appears that it had been jostled quite a bit. It's difficult to tell the angle of the original wound but everything I saw is consistent with someone standing in front of her and stabbing on a very slight angle upward."

She pulled Josie toward her with her left hand and used her right hand to drive an imaginary awl into Josie's stomach, swinging the weapon low before bringing it up into Josie's abdomen. "The hilt left an imprint on the skin of her abdomen which is consistent with what we know about the car accident."

Noah said, "But she would have died regardless of the stabbing?"

Anya sighed, looking at April Carlson's face. "Eventually, yes, if she didn't get medical attention. It's impossible for me to say how long she would have had without knowing the exact conditions of where she was before Mira Summers's car, but wherever it was, she wasn't getting enough food or sun."

"Walk us through your findings," Josie said. "From the beginning."

Anya nodded. "April Carlson is an extremely malnourished adult female. External exam showed several characteristics consistent with long-term starvation: sunken eyes and abdomen, bony protuberances, cracked lips, dental erosion, purpura—" She moved to April's feet and lifted the sheet, folding it up to her knees. Skeletal legs set Josie's stomach roiling. Anya pointed to a smattering of dark pink, almost purple, patches across April's shins. "This is often due to deficiencies of Vitamin C and K in cases of starvation." She pushed the sheet up, revealing thigh bones just as thin as the lower legs. More of the pink-purple spots dotted April's skin. Anya pointed out a few other places where the skin looked like April had a permanent case of gooseflesh. "This indicates a deficiency in Vitamin A."

Josie moved from one side of the table to the other, noting a tattoo on the outside of April's right ankle. Three pink flowers along a green stem, their petals almost like fans.

"A sweet pea," Josie said, almost to herself.

"What?" Anya said.

Josie gestured toward the tattoo. "The flower. It's called a sweet pea. It's one of the birth flowers for the month of April."

Both Noah and Anya joined her near April's right ankle. "How do you know that?" Anya asked.

"Her father," Noah said. "Well, Eli Matson. He used to take her hunting for wildflowers. But sweet peas aren't wildflowers, are they?"

"I'm not sure if they're officially considered wildflowers," Josie said, staring at the tattoo. "But Dad and I—Eli and I—often found them on our travels." Her heart clenched at the memory of Eli, his eyes that deep, deep blue like Sawyer's, smiling at her, and holding the flower out to her. "A sweet pea for my sweet pea," he used to say, making her giggle. Making her feel loved—such a stark difference to what waited for them at home with Lila. At least she had that memory. Poor Sawyer had nothing of his father. Josie sucked in a breath, trying to shove the memory and all thoughts of Sawyer back inside their boxes.

"Sorry," Noah said softly. "I know even the good memories can be painful."

"Isn't that the truth," Anya sighed.

"It's fine," Josie said, steadying herself mentally.

Anya pulled the sheet back down, leaving April's feet exposed from the ankles. "In addition to my other findings on external exam, I noted abrasions of the ankles and feet, consistent with her walking barefoot over rough surfaces and perhaps through brush."

Noah rounded the table to get a better look at the slashes along Jane Doe's ankles and the scrapes on the soles of her feet.

Anya continued. "Internal exam showed no signs of sexual assault. Several of her organs were underweight. Her intra-abdominal and abdominal wall fat were severely decreased compared to what I would expect to find in a healthy woman of her age. Her pancreas showed signs of atrophy. The left ventricle of her heart showed a loss of mass and volume—again, compared to what I would expect to find in someone her age in reasonably good health. All of these things together are consistent with starvation that took place over a long period of time."

"Is it consistent with how long she's been missing?" asked Josie.

"I believe so. Other findings support that she may have been deprived of food and sunlight for up to a year." She waved them over to the laptop, closing out photos of the awl in favor of X-rays. "She showed the beginnings of osteomalacia."

"What's that?" asked Noah.

"Softening of the bones," Anya said. "It's from a lack of Vitamin D. Now, that can be from starvation as well, but it is also consistent with not getting enough sunlight over a long period of time."

"Like a year," Josie said.

"Exactly." Anya pulled up X-rays of April's right shoulder and collarbone. "Could be more or slightly less. If it had gone on much longer, I'm not sure she would have survived. Here." She pointed to where the ball of the shoulder met the collarbone. A portion of April's ribs was also visible. Between them and the humerus, the edge of the scapula could be seen. Just below the shoulder joint was a thick, dark line that otherwise marred the hazy whiteness of the bones. Anya pulled up a view of the left scapula, showing a mirror image.

Noah said, "Are those fractures?"

"Pseudofractures," Anya answered. "Also called ‘Milkman lines' after an American radiologist who presented his findings on them all the way back in the 1930s. Also sometimes called ‘Looser's zones' after a Swiss doctor named Emil Looser. These are incomplete fractures. They never heal properly or completely because, since the bone is demineralized, new bone never strengthens. A pseudofracture alone is not enough to diagnose osteomalacia unless they are bilateral and symmetrical and found in what are considered classic locations like this or the ribs or ulna."

"Would it have been painful?" asked Josie.

"Yes," said Anya. "Although April was probably in agony from her body slowly wasting away and shutting down as well."

Noah's eyes flared with anger. "Imagine stabbing someone in this condition."

Josie sidled over to him and discreetly touched his hand. Looking back at Anya, she asked, "Would April have been able to walk? Before or after she was stabbed?"

Anya shook her head and snapped her laptop closed. "That is impossible to say. If she was able to walk, it would not have been very far. Once she was stabbed, I doubt she would have been able to walk at all."

"Was there anything in her stomach?" asked Josie.

Anya winced. "Mud. Some grass."

Josie said, "Which means that, at least recently, she'd been kept somewhere that she could access mud and grass."

"Right," said Anya.

Josie could feel Noah getting more agitated, rage rolling off him in waves. He took a step away from them and pushed his fingers through his thick brown locks.

"We'll find the person who did this," Josie promised him.

"Then we'll make him pay," Noah added.