Chapter Sixteen

Completely covered by long, teal-colored surgical sheets, the five bodies inside the pathology theater at the Ronald Reagan Medical Center in UCLA were lying on wide, stainless-steel autopsy tables. A green folder sat on top of the instruments tray, by every table. It contained the official police report and some background information on the body, but the students weren't allowed to look at it until Dr. Hove gave them the green light.

‘OK,' she said, as she gestured toward the autopsy tables. ‘We have three male bodies and two female ones. They were brought into the theater earlier this morning and, to be honest with you, I really don't know which one is which. I haven't looked.'

‘Can we choose?' a tall and slim student asked. Her long, barley-colored hair was clipped at the top by a claw-clip.

‘Will you be able to choose in real life?' Dr. Hove challenged her.

‘I guess that if you're the chief medical examiner you could have your pick.' The reply came from Kenny, which once again got him a few scattered laughs.

‘Wow,' the doctor chuckled. ‘Four to five years still to go and you're already gunning for my job? Good luck. Just try to keep all your fingers attached to your hands before graduation day, all right?'

This time, even Kay had to laugh. She really didn't like Kenny.

‘OK, everyone.' Dr. Hove's tone was back to serious. ‘Get your groups by an examination table. No peeking.'

She waited until every group had paired itself up with a body.

‘Are we all set?' she asked, her stare moving slowly from group to group.

Another united chorus of agreement.

‘I'm giving you all a total of two hours and fifteen minutes,' Dr. Hove announced, indicating the clock high on the theater's back wall. ‘So each member in the group will have forty-five minutes as the head pathologist.' This time, her stare found and settled on Kay Sixtree. ‘The head pathologist is allowed to do whatever he/she wants. The other two members of the group – the assistants…' The pause that came after the word was deliberate. ‘May observe and perhaps suggest something, if… and only if…' Another pause, this one accentuated by the doctor's index finger up in the air. ‘The head pathologist asks for advice, otherwise keep your opinions to yourself. Is that understood?'

While all the other students nodded and muttered their agreement, Tullik and Myeong both turned to look at Kay, their eyebrows arching, silently asking her the exact same question Dr. Hove had posed to the class.

Kay crossed her arms in front of her chest as she shrugged. ‘I won't say a word. Do what you must.'

‘All right,' Dr. Hove said, her gaze once again finding the clock on the wall. ‘Have all of you decided on who is head pathologist first?'

Murmurs took over the theater again.

Tullik and Myeong's eyes returned to Kay, who stood still, her poker face giving nothing away.

‘I can go first,' Myeong said. Her voice was naturally quiet and so sweet, sometimes Kay believed that she could get a cavity just by listening to Myeong talk.

‘I'll go second then,' Tullik was fast to suggest, as his attention returned to Kay. ‘If you don't mind.'

Kay knew exactly why they wanted to go before her. She wasn't only the best student in her class. She was also very fast and precise with a scalpel. If she went first, she could easily cover more ground in her forty-five minutes than Tullik and Myeong could in their combined hour and a half. Once she was done, there probably wouldn't be that much left for the two of them to examine. Plus, if Kay went last, it meant that she would probably have a chance to do the brain autopsy.

‘I don't mind,' Kay said, the corners of her lips stretching, but not into a smile. It was more like a mouth shrug. ‘I can go last if you guys want to go first.'

‘Great,' Tullik said, while Myeong repositioned herself around the autopsy table, moving closer to the instruments tray.

‘We're all ready, then?' Dr. Hove asked one last time.

Everyone in the class nodded.

‘OK, your time starts… now.' The doctor finally gave everyone the go-ahead as she clicked a button on her wristwatch. ‘I'll give you all a heads-up when you're ten minutes from time… then again at five minutes. And remember – treat the body with respect. They deserve it just as much as the living.'

More, even,Kay thought, but kept it to herself.

Kay, Tullik and Myeong had chosen the third autopsy table – the one right in the center. As Dr. Hove finally gave everyone the go-ahead, Tullik pulled the surgical sheet away, revealing a tall, white, male subject. The subject looked to have been in his early to mid-fifties when he died, but Kay, Tullik and Myeong all knew that with death, human skin would quickly acquire a different tone, dehydrate, lose elasticity and wrinkle. Add that to days spent in cold storage and correctly guessing someone's age at the autopsy table became a magic trick that very few got right.

The body had already been stripped naked and the injuries to it made all three of them cringe – his right leg was twisted out of shape, with his ankle completely bent backward, showing a comminuted open fracture. His left leg didn't look broken, but it was cruelly bruised. There were three other exposed fractures – right forearm and elbow, and right shoulder – while his left wrist and shoulder looked visibly dislocated. His torso was covered by different-sized hematomas, which were a sign of at least two broken ribs, but it was his head that made even Kay Sixtree shiver in place. The right side of his face was damaged beyond recognition – cheekbone and jaw broken, with the skin and flesh lacerated. On his skull, just above his right ear, there was an impact dent so severe that they could see the fracture to his cranium, leading all the way to his gray matter. Kay didn't need to do a brain autopsy to know that bone fragments from his skull had broken inward and perforated his brain.

‘Jesus!' Tullik said, taking a step back, unable to peel his eyes from the body. ‘What happened to him?'

‘This is a suicide victim?' Myeong asked. ‘What did he do, jump into a meat grinder?'

‘He probably either stepped in front of high-speed incoming traffic,' Kay replied, reaching for the file on the instruments tray. ‘Or he jumped from a building… a bridge… some place high off the ground.' She nodded at the body. ‘Those are high-impact fractures and lesions.'

‘Poor guy,' Myeong said as she exhaled. ‘I wonder what he must've been going through to believe that he had no other way out other than to do this to himself.'

‘That's a cardinal sin if you're a forensic pathologist,' Kay said, as she flipped open the file in her hands.

‘I know,' Myeong replied, lifting a hand in an apologetic gesture. ‘I'm not getting personal with the body. I've just always been fascinated by the kind of darkness that can lead a person to end his or her life with extreme prejudice like this. Especially so late in life.'

‘How old would you say he was when he died?' Tullik asked.

Myeong shrugged. ‘Somewhere in his fifties… sixties, possibly?'

Tullik nodded, signaling his agreement.

‘Even if you knew what had led him to this,' Kay offered, ‘chances are it wouldn't make too much sense to you. But it did to him. He simply had had enough.' She once again indicated the body. ‘Are you ready to start? Your time is ticking.'

‘I am.' Myeong took a second to recompose herself.

The autopsy body-block had already been put in place. This was a thick block made of rubber that was placed under the body's back to make the chest protrude forward, so that the arms and neck fell back, making cutting a lot easier.

Finally ready, Myeong nodded at Tullik, who started the digital recording.

Myeong began by giving a detailed description of the body's appearance, including ethnicity, gender, and hair and eye color, but when Myeong pulled open the body's eyelids to register his eye color, Kay frowned.

‘That's odd,' she said, stepping closer and bending over to get a better look.

‘What is?' Myeong asked.

‘Just around his bottom eyelid,' Kay replied, and used her index fingers to pull down the body's right and left lower eyelids. ‘Here, can you see it?'

There was an odd color change right on the inside edge of both eyelids.

‘Yeah, so?' Tullik challenged, his tone already dismissive. ‘Skin discoloration happens after death, you know?'

‘That's not post-mortem discoloration,' Kay told him.

‘Oh really?' Tullik pushed. ‘So what is it then?'

‘I don't know.' Kay was still analyzing the subject's lower eyelids. ‘Some sort of burn mark or skin irritation, for sure. We'd need a biopsy to properly determine what this is.'

‘No, it isn't,' Tullik disagreed, also stepping a little closer to have a better look. ‘And no, we don't need a biopsy, Kay. That's post-mortem discoloration, pure and simple.' He paused and looked at Myeong. ‘What do you think?'

‘I'm not really sure either,' Myeong replied, giving them a shy shrug. ‘I think that the best we can do right now is describe it as part of the external examination, noting your observation that a biopsy could be needed.' She addressed Kay. ‘How does that sound?'

Kay was about to say something, but Tullik saw it coming and halted her with a look. ‘No butting in until it's your turn, Kay, remember? You agreed. Myeong is right – the best we can do right now is to describe it as part of the external examination.'

Kay accepted it with a nod before positioning herself at one end of the autopsy table, by the body's feet. Her eyes moved down to the file that she had with her and she was immediately surprised to find out that the man they were looking at was not in his fifties or sixties like Myeong and Tullik had initially thought. Not even close. His name was Terry Wilford and he was only forty-three years old at the time of his death.

In the police report, Kay found out that Mr. Wilford's body had been found a week ago by two LA Sanitation Environment Division employees, as they cleaned the LA River concrete channel during their nightshift. Terry Wilford had jumped off the 7th Street Bridge.

Kay returned the file to the instruments tray and allowed her attention to go back to the body. When Myeong spread the body's legs just a couple of inches to get a better look at the inner thighs, Kay caught a glimpse of something else that immediately intrigued her.

‘Myeong,' Kay said, grabbing her colleague's attention. ‘Have you seen this?' She indicated the body's right foot.

Myeong and Tullik joined Kay at the far end of the examination table.

‘What am I looking at?' Myeong asked.

‘Right there,' Kay said, as she indicated. ‘In between the big toe and the pointer one.'

Myeong used both of her index fingers to spread the two toes apart. There was something that looked like some sort of lesion on the soft flesh between those two toes.

‘So he suffered from athlete's foot,' Tullik said, after looking at the lesion for a mere second.

‘I don't think that's athlete's foot,' Myeong said, as she looked between all the other toes.

Just like the color change in his eyelids isn't post-mortem discoloration,Kay thought, but kept it to herself.

‘Why not?' Tullik disputed.

‘Athlete's foot is a fungus infection,' Myeong replied. ‘It's caused by damp socks or shoes together with warm and humid conditions—'

Tullik chuckled, as he cut Myeong short. ‘Well, you just described LA's yearlong weather. All he needed to do was go for a long run and step into a puddle right at the beginning of the run. Keep the wet shoes and socks on for longer than necessary and bingo, bango, bongo.' He pointed to the body's right foot. ‘Athlete's foot.'

‘True,' Myeong agreed. ‘But you didn't let me finish – because it's a fungus infection, it's practically impossible to develop it in between only two toes. Inside a close and tight environment like a shoe, it would've spread like butter.' She finished checking the rest of the body's right foot. ‘But we don't have that here.' She indicated, so that Tullik could have a look. ‘All his other toes look healthy.'

Kay quickly checked the body's left foot, where she found a very similar lesion, once again, only between the big and the pointer toes. ‘And he's got the exact same thing on his left foot.'

‘OK,' Tullik lifted his hands in a tentative surrender gesture. ‘So it's not athlete's foot, but it's clearly just some other skin condition.'

‘Like what?' It was Kay's turn to challenge him.

‘It could be one of many different types of eczema,' Tullik offered, while reaching for the file that Kay had returned to the instruments cart. ‘Or even psoriasis. With his skin in the condition that it is now, we'd need a full lab analysis to know for sure.'

That paused Kay for an instant. Tullik did have a point. The lesion between the toes could be psoriasis.

‘Regardless of what that really is…' He pointed at the body's feet before turning to face Myeong. ‘I can tell you what it's not.'

Myeong's eyebrows lifted at him.

‘That's not the COD,' Tullik continued. ‘Which is what we're supposed to be identifying here. It's also none of the other things that Dr. Hove asked us to unearth – old surgeries, bone breaks… whatever. If you want to spend any more of your "fast running out" forty-five minutes on some "who gives a damn" toe infection, go right ahead. I'm sure that Kay would love you to do so, but when my turn comes, I'm cutting right into him because that's what great pathologists do.'

Tullik delivered those words in such a way that Myeong looked at Kay a little sideways, as if the lesions on the body's toes had been some sort of expert ploy from Kay to make the other two group members waste their time as the head pathologist.

Myeong took in a deep breath before addressing Kay. ‘Tullik is right. I've already wasted way too much time here. Whatever that is, it isn't important. I'll describe it for the benefit of the recording once again, like I did with the eyelid discoloration, but the decision is mine and I'm moving on.'

Myeong quickly completed the external examination while her ‘assistants' collected samples of hair and debris from under his fingernails for lab analysis, if needed.

‘I'm ready to start,' Myeong announced.

Kay and Tullik stepped closer.

Myeong retrieved a long scalpel from the instruments tray, stepped up to the body and started the famous ‘Y' incision, cutting from both shoulders to the lower end of the sternum and then downward, in a straight line, over the abdomen to the pubis.

‘I'm going to need a little help with the pulling,' Myeong said, her gaze moving from Kay to Tullik.

‘We're on it,' Tullik replied.

Kay and Tullik used special scissors and toothed forceps to peel back skin and soft tissue, pulling the chest flap over the body's face to expose the ribcage and neck muscles.

‘Oh, Jesus!' Myeong said, indicating two clearly visible severe fractures to the ribcage – frontal, right side – ribs four and five. ‘Very big contenders for the COD, right here.'

With both fractures, the ribs had broken completely free from the cage and, in both cases, perforated the subject's right lung.

‘He wouldn't have survived this,' Myeong announced. ‘Not without immediate assistance.'

‘Definitely not,' Tullik agreed, but Kay stayed quiet.

The injury was real. Kay could clearly see that, but she could also clearly see that something didn't seem right. She bent over the body to have a closer look.

‘You look doubtful, Kay,' Myeong said. ‘Don't you agree with my assessment?'

‘I'm not doubtful about the injury,' Kay replied, using her left hand to gently move one of the ribs that had implanted itself into the subject's lung. ‘This would've definitely been life-threatening, but…' Instead of finishing her sentence, Kay studied the perforations to the lung a little more closely.

‘But what, Dr. House?' Tullik asked, sarcastically referring to Kay's favorite medical TV drama series.

‘Don't you think that there's a lack of internal hemorrhaging?' Kay asked, indicating the area next to the lung. ‘There should've been more blood everywhere around here.' Using her left hand, she applied a little pressure to the lung, in a squeezing motion. ‘There should've been a lot more blood inside his lung too.'

‘You can't really tell if there is or not with a simple hand-pressure exam,' Tullik countered. ‘Not to mention the fact that he died a week ago and has spent the last few days lying in cold storage. To confirm the hemorrhaging, the lung has to be removed and autopsied, which is what we're about to do… if we're allowed to.'

‘Also,' Myeong offered, her sweet voice doing its best to sound authoritative, ‘like I've said, this is just a contender for the COD, but let's be honest here – his body is pretty mangled – and we just barely opened him up. A double-punctured lung isn't the only life-threatening injury we're going to find. I'm one hundred percent sure of that.'

Kay tilted her head, opened her mouth, then closed it again. She'd been about to raise a different point, but in the end, all she did was smile and nod.

Discussion over, Myeong used a bone saw to cut and remove the ribcage. Without its protection, extracting the larynx, the esophagus, arteries and ligaments was easy work.

Kay had to admit that she was quite impressed by how precise Myeong was with every autopsy cutting instrument she had reached for, but that precision came at a cost – time. By the time that she had finished severing all the attachments to the spinal cord and removing the internal organs as an entire set, Myeong's time as the head pathologist was over.

Tullik was quick to step into his new role and, as he did, he looked Kay straight in her eyes. ‘Not a peep from you from now on. This is my show now.'