“Air surrounding the heart and in the cardiac chambers, as well as in the pulmonary arteries and veins.”
“And you’ve never seen anything like this?” Benton asks me.
“Yes and no. Similar devastation caused by military rifles, anti tank cannons, some semiautomatics using extreme shock fragmenting high-velocity ammunition, for example. The higher the velocity, the greater the kinetic energy dissipates at impact and the greater the damage, especially to hollow organs, such as bowel and lungs, and nonelastic tissue, such as the liver, the kidneys. But in a case like that, you expect a clear wound track and a missile or fragments of one. Which we aren’t seeing.”
“What about air?” Benton asks. “Do you see these pockets of air in cases like that?”
“Not exactly,” I reply. “A blast wave can create air emboli by forcing air across the air-blood barrier, such as out of the lungs. In other words, air ends up where it doesn’t belong, but this is a lot of air.”
“A hell of a lot,” Ollie concurs. “And how do you get a blast wave from a stabbing?”
“Do a slice right through those coordinates,” I say to him, indicating the region of interest marked by a bright white bead— the radio-opaque CT skin marker that was placed next to the wound on the left side of the man’s back. “Start here and keep moving down five millimeters above and below the region of interest specified by the markers. That cut. Yes, that’s the one. And let’s reformat into virtual three-D volume rendering from inside out. Thin, thin cuts, one millimeter, and the increment between them? What do you think?”
“Point-seventy-five by point-five will do it.”
“Okay, fine. Let’s see what it looks like if we virtually follow the track, what track there is.”
Bones are as vivid as if they are laid bare before us, and organs and other internal structures are well defined in shades of gray as the dead man’s upper body, his thorax, begins to rotate slowly in three-dimension on the video display. Using modified software originally developed for virtual colonoscopies, we enter the body through the tiny buttonhole wound, traveling with a virtual camera as if we are in a microscopic spaceship slowly flying through murky grayish clouds of tissue, past a left kidney blown apart like an asteroid.
A ragged opening yawns before us, and we pass through a large hole in the diaphragm. Beyond is shattering, shearing, and contusion.
“I keep forgetting nothing works down here,” Benton comments distractedly as he looks at his iPhone.
“Nothing exited, and nothing is lighting up.” I calculate what must be done next. “No sign of anything ferrous, but we need to be sure.”
“Absolutely no idea what could have done this,” Benton states rather than asks as he gets up from his chair, making rustling sounds as he unties his disposable gown. “You know the old saying, nothing new under the sun. I guess, like a lot of old sayings, it’s not true.”
“This is new. At least to me,” I reply.
He bends over and pulls off his shoe covers. “No question he’s a homicide.”
“Unless he ate some really bad Mexican food,” Marino says.
It vaguely drifts through my thoughts that Benton is acting suspiciously.
“Like a high-velocity projectile, but there’s no projectile, and if it exited the body, where’s the exit wound?” I keep saying the same thing. “Where the hell’s the metal? What the hell could he have been shot with? An ice bullet?”
“I saw a thing about that on
“Maybe if you’re a sniper in the interior of Antarctica,” Ollie says. “Where’d that idea come from, anyway?
“I thought it was James Bond. I forget which movie.”
“Maybe the exit wound isn’t obvious,” Anne says to me. “Remember that time the guy was shot in the jaw and it exited through his nostril?”
“Then where’s the wound track?” I reply. “We need better contrast between tissues, need to be damn sure there’s nothing we’re missing before I open him up.”
“If you need my help with that, I can call the hospital,” Benton says as he opens the door. I can tell he’s in a hurry, but I’m not sure why.
It’s not his case.
“Otherwise, I’ll check on what Lucy’s found,” Benton says. “Take a look at the video clips. Check on a couple other things. You don’t mind if I use a phone up there.”
“I’ll make the call,” Anne says to him as he leaves. “I’ll get it arranged with McLean and take care of the scan.”
It’s been a theoretical possibility this day would come, and we are cleared with the Board of Health, and with Harvard and its affiliate McLean Hospital, which has four magnets ranging in strength from 1.5 to 9 Tesla. Long ago I made sure the protocols were in place to do MRIs on dead bodies in McLean’s neuroimaging lab, where Anne works as a part-time MR tech for psychiatric research studies. That’s how I got her. Benton knew her first and recommended her. He picks well, is a fine judge of character. I should let him hire my damn staff. I wonder whom he is going to call. I’m not sure why he is here at all.
“If that’s what you want, we can do it right now,” Anne is saying to me. “There shouldn’t be a problem, won’t be anyone around. We’ll just go right up to the front door and get him in and out.”
At this hour, psychiatric patients at McLean won’t be wandering around the campus. There’s little risk of them happening upon a dead body being carried in or out of a lab.
“What if someone shot him with a water cannon?” Marino stares as if transfixed at the rotating torso on the video screen, the ribs curving and gleaming whitely in 3-D. “Seriously. I’ve always heard that’s the perfect crime. You fill a shotgun shell with water, and it’s like a bullet when it goes through the body. But it doesn’t leave a trace.”
“I’ve not had a case like that,” I reply.
“But it could happen,” Marino says.
“Theoretically, however, the entrance wound wouldn’t be like this one,” I reply. “Let’s get going. I want him posted and safely out of sight before everyone starts arriving for work.” It’s almost midnight.
Anne clicks on the icon for
“So what that tells me…” I start to say.
“How about inches,” Marino complains.
“Some type of double-edged object or blade that doesn’t get much wider than half an inch,” I explain. “And once it penetrated the body up to an approximate depth of two inches, something else happened that caused profound internal damage.”
“What I’m wondering is how much of this abnormality we’re seeing is iatrogenic,” Ollie says. “Caused by the EMTs working on him for twenty minutes. That’s probably the first question we’ll get asked. We have to keep an open mind.”
“No way. Not unless King Kong did CPR,” I reply. “It appears this man was stabbed with something that caused tremendous pressure in his chest and a large air embolus. He would have had severe pain and been dead within minutes, which is consistent with what’s been described by witnesses, that he clutched his chest and collapsed.”
“Then why all the blood after the fact?” Marino says. “Why wouldn’t he have been hemorrhaging instantly? How the hell’s it possible he didn’t start bleeding until after he was pronounced and on his way here?”
“I don’t know the answer, but he didn’t die in our cooler.” I am at least sure of that. “He was dead before he got here, would have been dead at the scene.”
“But we got to prove he started bleeding after he was dead. And dead people don’t start bleeding like a damn stuck pig. So how do we prove he was dead before he got here?” Marino persists.
“Who do we need to prove it to?” I look at him.
