Dickhead.
Plate by plate, I worked my way through the passenger’s infrastructure. Ribs, vertebrae, pelvis, arm, leg, breast, and collarbone.
Other than massive deceleration trauma, the skeleton looked perfectly normal.
Until I popped up the last four plates.
I was staring at the passenger’s hands and feet when Larabee came up behind me. For a full ten seconds neither of us spoke.
Larabee broke the silence.
“Jesus Christ in a blooming pear tree. I hope that’s not what I think it is.”
15
I STARED INTO THE PATTERN OF GRAYS AND WHITES RADIATING from the X ray. Beside me, Larabee did the same.
“Could you see involvement when you examined the nasal bones?” the ME asked.
“One lesion.”
“Active?”
“Yes.”
I heard Larabee’s soles squeak on the tile, his palms rub up and down on his upper arms.
“Are you thinking leprosy?” he asked.
“Sure looks like it.”
“How the hell does someone get leprosy in North Carolina?”
The question hung in the air as I dug through layers at the back of my mind.
Graduate school. Systematics of bone pathology.
A: anatomical distribution.
I pointed the tip of my pen at the finger and toe bones.
“Other than the nasals, the process seems to be restricted to the bones of the hands and feet, especially the proximal and middle phalanges.”
Larabee agreed.
B: osseous modification. Abnormal size, shape, bone loss, bone formation.
“I see three types of change.”
I pointed to a punched-out-looking circle. “Some lesions look round and cystic, like the one on the nasal.”
I indicated a honeycombed pattern in the index finger.
“There’s lacelike coarsening in some phalanges.”
I moved my pen to a phalange whose shape had altered from that of a dumbbell to that of a sharpened pencil.
“Resorption in one.”
“Looks like classic radiology textbook leprosy to me,” said Larabee.
“Did you pick up hints of anything elsewhere in the body?”
Larabee turned both palms up and shrugged in a “not really” gesture. “A couple of enlarged lymph nodes, but they didn’t strike me as any big deal. The lungs were hamburger, so I couldn’t really see much.”
“With lepromatous leprosy, the most obvious skin lesions would have been on the face.”
“Yeah. And this guy didn’t have one.”
Back to my hindbrain.
No macroscopically observable changes in soft tissue.
Diffuse spotty rarefaction, cortical thinning, penciling of at least one phalange.
Down through the mental strata.
Neoplasias. Deficiency diseases. Metabolic. Infectious. Autoimmune.
Slow, benign course.
Hands and feet.
Young adult.
“But you can bet your ass I’ll take a close look at the histo when the slides are ready.”
Larabee’s words hardly registered as I thumbed through possible diagnoses. Leprosy. Tuberculosis. Spina
