Without Consent

1. E. coli pneumonia and sepsis. The endotoxins released by the bacteria are the most likely cause of the increased bleeding tendency, which resulted in the skin bruising, retinal hemorrhages and the large intracranial bleed.

2. Probable scurvy, from chronic Vitamin C deficiency or an accelerated metabolism of Vitamin C. This would account for the excessive fragility of blood vessels, exacerbating bleeding problems, and the increased tendency for bones to fracture. Metabolism of Vitamin C would have been rapidly increased in the presence of sepsis and intercurrent viral infection. The history of recurrent respiratory infections can be attributed to scurvy, which significantly reduces the effectiveness of the immune system.

3. Fractured ribs due to excess force during cardiac massage in the failed resuscitation attempt, irrespective of pre-existing brittle bones.

In conclusion, the child died from natural causes. The history of recurrent viral infections, bleeding and bone fractures are most likely the effects of chronic Vitamin C deficiency. This death would have been prevented if the emergency doctor had administered large doses of intravenous Vitamin C on the initial presentation.

Anya re-read the conclusion in complete disbelief. Not only did Carney ignore the possibility of child abuse and murder, he accused the treating physician of negligent homicide! He had failed to state that cardiac massage could cause fractures of the front, not the back ribs. There was no comment at all about the suspicious marks on the child’s back, and no slides were taken to confirm the pathology. In this case, all the physical evidence pointed to severe physical trauma from child abuse. A statement from Community Services mentioned that the family was under investigation following a complaint from the child’s maternal grandmother, who suspected abuse. Another, from a neighbor, claimed that the night before the child died she had heard a male voice screaming at a crying baby.

Based on the pathology report, the police would have been unable to pursue a case of abuse. Anya put the report on the rug and unpacked her laptop. She plugged in the power cord just as the phone rang. Unable to locate the handset, she pressed the microphone on the base station.

“Mummy!”

“Hi, Ben! I’ve just been thinking about you.”

“Hey, me too.”

“How are you feeling? Yesterday you sounded terrible.”

He took a deep breath to prove the lack of snuffles. “All better.”

“That’s great news. Did you go to preschool?”

“Yeah, but it’s a little bit boring.”

Ben rarely talked about preschool over the phone. There was no point asking any more about it.

“Mummy, what are we doing when I come to sleep over?”

“Well, I’ve been practicing a new song on the drums. Maybe we can play it together. And we might go to the Powerhouse Museum again. There’s a huge Star Wars exhibition.”

“I love Star Wars! How did you know?”

“Maybe I just know you.”

There was silence for a moment. Then Ben’s voice almost whispered, “Love you, I miss you.”

“Me too, Speedie. Me too. Love you all the way to forever and back again.”

“And way past there…Uh, Dad’s calling. It’s bath-time.”

“Then you’d better go and get clean. I’ll see you tomorrow.”

“Okay. Bye.”

Before hanging up, she waited to hear the click at the other end.

At least her son was over his latest head-cold. Like other preschoolers, he had a constant runny nose, ear- infections and skin rashes that could only be described as “viral.” Any mother knew that the first years of contact with other children brought an endless string of respiratory and gastric infections. He was owed more swimming lessons than he’d been well enough to attend.

She wondered whether Alf Carney had children. Surely not, she thought, otherwise he would have known that was a normal process in young children, not pathological, and certainly not diagnostic of scurvy.

She picked up the second autopsy report-of another child, an eight-week-old boy, with the same surname as the first. Retinal hemorrhages, bruised chest and forearms; the pattern of injuries was disturbingly similar. This time, Carney concluded even more strongly that the child had died from natural causes, with a familial case of Vitamin C deficiency. After all, Carney had examined the baby’s sister, who had died of the same thing a year before. He referred to the previous report as confirmation. Again, the police were unable to act without a PM report that showed abuse or interference.

Anya began to type her report on these first two cases. Two hours later, she had referenced all her comments and felt satisfied that the cases should be reopened, based on the overwhelming evidence of abuse. In developed countries, scurvy was virtually unheard of, except in cases of severe malnutrition associated with abuse. Even milk contained Vitamin C, so small children were extremely unlikely to get this condition, even on a diet lacking fruit and vegetables.

With ten more files to review, Anya glanced at the clock. Too early to sleep and with only reality shows on TV, she decided to find out how many more cases of scurvy Alf Carney had stumbled upon.

In each of the next four cases, microscopic examinations had been minimally performed. In the sixth file, the slides had been provided for an elderly man found drowned on a beach at the south coast. The man had a number of lacerations to the head, which Carney explained as being post-mortem injuries, despite bleeding from the site. Although some head lesions oozed serum, especially in water, despite no blood flowing through a body, a large amount of blood from a wound suggested arteries still pumped blood at the time of the injury. Anya collected the slides of the biopsy of the skin from the laceration site and headed to the front room, her office. For economy, Anya did her private work downstairs in the front rooms of the terrace house and lived upstairs. During work hours, the kitchen, bathroom and lounge room were shared with her secretary. Once inside, she switched on the light and carried her small microscope over to the desk. After focusing the lens, she could make out individual characteristics of hordes of tiny cells fixed to the glass. The skin specimen showed a rim of early inflammatory changes around the wound. Double-checking, she noted the infiltration of neutrophils, part of the body’s defense system essential for preventing infection while the wound heals.

For these cells to be around the site, the elderly man had had to be alive when the wounds were inflicted. The injuries could not have been sustained after death, by knocking against rocks near where he was found. The diagnosis of accidental drowning needed to be reviewed in the presence of multiple lacerations to the scalp, and they were unlikely to have been self-inflicted. The death had to be deemed suspicious, and the case reopened.

Anya sat back in her chair, astounded by the conviction with which Carney excluded foul play in the most suspicious cases. The implications were enormous.

Could one pathologist possibly be that incompetent, or did he have his own agenda? If Carney’s evidence had stopped murders being investigated, how many killers had escaped prosecution? Like every pathologist, he had worked on thousands of cases over the years. The ramifications for the legal system were enormous. Morgan Tully’s “political time-bomb” was set to go off.

8

Anya arrived early at the unit to catch up on paperwork. She checked the time-seven a.m. Four hours before her meeting with Dan Brody.

Within minutes, Mary knocked on the door with a cup of steaming black coffee.

Anya looked up after smelling the brew. “What did I do to deserve this so early?”