The Jodi Picoult Collection #2 Read online

  CORONER’S REPORT

  CAUSE OF DEATH: HANGING

  MANNER OF DEATH: SUICIDE

  Significant associated findings:

  Recent childbirth, at or near term.

  EXTERNAL EXAMINATION

  External exam: The body is that of a well-developed well-nourished white female who appears the stated age. Hair is blond. Irides are brown. Pupils are equal and measure 6mm each. The body measures sixty-two inches in length and weighs 124 pounds. No scars are identified. There is moderate rigor. Moderate livor is noted in the hands, forearms, feet and legs. There is slight livor noted on the back of the trunk.

  The eyes are prominent. A 2 cm red groove is noted in the neck, more prominent anteriorly. It extends from just above the level of the thyroid cartilage to the level of the ears. Petechiae are noted in the skin above the groove. Bloody mucus exudes from the mouth and nares. The tongue is protuberant and the protruding tip is dusky and dry. Linear scratch marks are noted in the skin of the neck.

  Examination of the thorax reveals the breasts are engorged. No ecchymoses are identified.

  Examination of the abdomen reveals a protuberant abdomen with striae noted. The uterus is palpated four inches above the pubis.

  Examination of the extremities reveals multiple ecchymoses on both shins and wrists.

  INTERNAL EXAMINATION

  The body is opened through a standard Y-incision. The thoracic and abdominal viscera are in their appropriate positions. There is no measurable pleural or peritoneal fluid. Examination of the neck reveals no evidence of fracture of the thyroid cartilage or hyoid bone. There are ecchymoses only underneath the externally noted groove.

  The right lung weighs 300 grams and the left lung weighs 280 grams. There is minimal congestion in the posterior aspects of the lower lobes bilaterally. The heart weighs 350 grams. No abnormalities are identified.

  The liver weighs 1200 grams and on sectioning it contains 600 cc of liquid blood. The liver otherwise shows mild nutmeg appearance. The pancreas, gallbladder, and biliary tree are unremarkable. The spleen weighs 100 grams. It is unremarkable externally and on sectioning. Examination of the stomach reveals a small amount of partially digested food. No pills are identified. No abnormalities are noted in the intestines.

  The kidneys, ureters, and bladder are normal in location and contour.

  The uterus weighs 450 grams. The endometrial lining is thick and hemorrhagic. The wall measures 2 cm in thickness. Examination of the ovaries reveals a 2 cm corpus luteum in the right ovary. The left ovary is unremarkable.

  The abdominal aorta and vena cava are unremarkable. There is minimal postmortem hemorrhage. Examination of the brain and spinal cord shows no significant gross abnormalities.

  MICROSCOPIC EXAMINATION

  Sections of the ecchymotic area over the right flank show small numbers of segmented neutrophils around the extravasated red cells. Sections of the lungs show mild congestion and edemA. There is no evidence of pneumoniA. Sections of the liver hematoma confirm the gross impression of blood without significant organization. Sections of the other viscera are unremarkable.

  “Translate for me, Wesley,” Eli said. He sat on the porch of the old man’s house, holding a sweating glass of lemonade. Watson had turned himself into an area rug beneath the hanging cedar swing.

  Wesley Sneap had been the town doctor back when there were town doctors—and by default, the county coroner until 1985. The coming of HMOs, plus a shaking scalpel hand, had pushed Wesley into retirement. However, he still kept a microscope and makeshift lab in his basement. And sitting on a sideboard in his parlor was his old black medicine bag, just in case someone should call for assistance.

  “Well,” he sighed, “she was hanged, all right. You could see it in her face, and in the way she scratched at her neck.”

  Eli leaned forward, hands clasped. “What else?”

  The doctor skimmed the report again. “Lot of the notes just confirm a recent delivery of a baby . . . the thickness of the uterus, the colostrum, the size of the heart. Oh, and she had a fight with someone a few hours before the hanging. There are bruises on her shins and her wrists, but only the wrists show inflammation in reaction to the injury. The bruises on her shins don’t, because she died before there was time for a cellular response. Probably was kicking like the devil to get free.”

  “What was the time of death?”

  “Let’s see.” Wesley frowned. “Nothing in her stomach, but then again she was busy giving birth. We can guess the hanging interval though . . . it was long enough for there to be livor—blood pooling, that is—in the legs and lower arms . . . at least four or five hours. But she wasn’t hanging much longer than that, because it would have been fixed. Instead, there was some redistribution of blood to the back of the trunk after she was cut down.”

  “The husband told the cops he cut down the body around ten-thirty in the morning . . . but that the killer came into the house in the middle of the night.”

  Wesley shook his head. “Doesn’t fit. Based on the autopsy report, if she was cut down at ten-thirty in the morning, then she was hanged at around six A.M.”

  “What if she was hanged in the middle of the night?” Eli asked.

  “Then she was cut down by six or seven A.M. Otherwise, the livor would have been fixed and wouldn’t have redistributed to the back of the trunk.”

  He picked up one of the slides that had been tucked into the autopsy report, holding it up to the light. “Huh.”

  “What’d you find?”

  “Well, the old ME mentioned a bruise on the right flank, and then he talks about a liver hematomA. He seems to have chalked those up to some physical traumA. See here, when he talks about that nutmeg liver? He thought they were expanded blood vessels, from right-sided heart failure.”

  “So what?”

  “Imagine it like a backed-up drainpipe: when the heart isn’t working well, everything jams up in the liver. But she died instantaneously . . . and there wouldn’t have been time for this kind of reaction.” He squinted at the slide. “Come downstairs with me. I want to take a closer look.”

  Eli followed Wesley down to the basement. Where most men had a workshop or an exercise room, Wesley had a stainless-steel examination table and a counter full of instruments and microscopes. “I remember this case,” he said, pulling stain from a shelf. “When I came to Comtosook in 1943, folks still talked about it. In fact, I can recall how teenage boys used to hide in the woods at the Pike place on Halloween night, so that they could live to tell about it in the halls of the school the next day.”

  “Yeah? What did they say?”

  “Not much, come to think of it. They’d go out there as a dare, and come back quiet as church mice. I once treated a fellow, a football star, who couldn’t speak for the whole month of November. Had him go to Boston, to have his larynx checked out by a hoity-toity specialist and everything.”

  “What was wrong with him?”

  “Not a thing, physically. Started talking again one day as if there’d never been a problem.”

  “You think something happened to him at the Pike property?”

  Wesley shrugged. “I think things can happen to a body that never make it to the medical books. Like how grief can kill you, or how falling in love can give you the bed spins. I never thought that boy had any damage to his vocal cords, no matter how many fancy tests those city doctors sent him for. And I was right all along—that’s what had come of swallowing sadness.” He slipped the slide beneath the microscope and sucked in his breath. “Aha.”

  “What is it?”

  “Fibrin deposition within the periportal sinusoids, and microscopic areas of hemorrhage. And coagulative necrosis in the periportal hepatocytes.”

  “Jesus, Wesley. English.”

  Wesley took off his glasses, then rubbed his eyes. “Preeclampsia is a serious complication of pregnancy. It gets even more serious when it causes the HELLP syndrome—that’s short for hemolysis, elevated liver enzyme