The Jodi Picoult Collection Read online

  “Yes. He was a premature liveborn male infant with no congenital abnormalities. There was evidence of acute chorioamnionitis, as well as some meconium aspiration and early pneumonia. There were various indications of perinatal asphyxia. Additionally, there were perioral ecchymoses and intraoral cotton fibers that matched the shirt the infant was found in.”

  “Let’s break that down a bit for those of us who didn’t go to med school,” George said, smiling at the jury. “When you say it was premature and liveborn, what does that mean?”

  “The baby wasn’t carried to term. Its skeletal age was consistent with a gestational age of thirty-two weeks.”

  “And liveborn?”

  “As opposed to stillborn. The lungs of the infant were pink and aerated. Representative samples of each lower lobe, with a control sample of liver, were suspended in water. The lung tissue floated, while the liver sank—which indicates that the infant was born and breathed air.”

  “How about a lack of congenital abnormalities—why is that important?”

  “The baby would have been born viable. There were also no chromosomal defects and no evidence of substance abuse—all significant negative findings.”

  “And the chorioamnionitis?”

  “Basically, it’s an infection in the mother that led to premature delivery. Additional examination of the placenta ruled out the usual other common causes for premature labor. The cause of the chorioamnionitis was not identified because the fetal tissues and placenta were contaminated.”

  “How did you know that?”

  “Microbiological studies revealed diphtheroids—common contaminants—in the fetal tissues. The placenta is rarely sterile after vaginal birth, but this one had been sitting in a stable for some time before being retrieved, as well.”

  George nodded. “And what is asphyxia?”

  “A lack of oxygen, which eventually led to death. Petechiae—small hemorrhages—were visible on the surface of the lungs, thymus, and pericardium. A small subarachnoid hemorrhage was found on the brain. In the liver were patchy zones of necrosis of hepatocytes. These findings sound very exotic, but are seen with asphyxia.”

  “What about the ecchymoses and cotton fibers?”

  “Ecchymoses are small bruises, in layman’s terms. These were all approximately one to one-point-five centimeters in diameter, all surrounding the mouth. Scrapings of the oral cavity revealed fibers that matched the shirt.”

  “What did these two observations lead you to believe?”

  “That someone had stuffed the shirt in the infant’s mouth and attempted to cut off his air supply.”

  George let that sink in for a moment. “Was the umbilical cord examined?”

  “The attached portion of the umbilical cord was twenty centimeters in length, with no tie or clamp present on the cord, although the end was crushed as if a ligature had been present at some time. Fibers present on the cord stump were submitted to Trace Evidence for analysis and matched baling twine found in the barn. The cut surface of the cord was jagged, had bits of fiber on it, and indicated a small demarcation in the center.”

  “Is that important?”

  The doctor shrugged. “It means that whatever was used to cut the cord, most likely scissors, had a notch in one of its blades and had been used to cut baling twine.”

  “Doctor, based on all this, did you determine a cause of death for Baby Fisher?”

  “Yes,” Edgerton said. “Asphyxia, due to smothering.”

  “Did you determine a manner of death?”

  The medical examiner nodded. “Murder.”

  * * *

  Ellie took a deep breath, stood, and approached the medical examiner. “Dr. Edgerton, are the ecchymoses around the mouth conclusive proof of smothering?”

  “The proof of smothering is in the many organs that show signs of asphyxia.”

  Ellie nodded. “You mean, for example, the petechiae in the lungs. But isn’t it true that you cannot tell from an autopsy exactly when that asphyxia occurred? For example, if there was a problem with placental blood flow before or during birth, couldn’t it cause a loss of oxygen in the fetus, which would show up in the autopsy?”

  “Yes.”

  “What if there was a problem with placental blood flow just after birth? Might that result in signs of asphyxia?”

  “Yes.”

  “How about if the mother were bleeding or having trouble breathing herself during the delivery?”

  The medical examiner cleared his throat. “That too.”

  “What if the baby’s lungs were immature, or if it were suffering from poor circulation or pneumonia—would that lead to evidence of asphyxia?”

  “Yes, it would.”

  “And if the baby choked on its own mucus?”

  “Yes.”

  “So asphyxia may be caused by many things other than homicidal smothering?”

  “That’s correct, Ms. Hathaway,” the medical examiner said. “It was the asphyxia, in conjunction with the bruises around the oral cavity and the fibers found within it, that led to my specific diagnosis.”

  Ellie smiled. “Let’s talk about that. Does the evidence of a bruise prove that someone held a hand over the baby’s mouth?”

  “The bruise indicates that there was local pressure applied,” Dr. Edgerton said. “Make of it what you will.”

  “Well, let’s do just that. What if the baby was delivered precipitously, and landed on his face on the barn floor—might that have led to bruises?”

  “It’s possible.”

  “How about if the mother grabbed for the infant as it was falling after that delivery?”

  “Perhaps,” the doctor conceded.

  “And the fibers in the oral cavity,” Ellie continued. “Might they have come from the mother wiping mucus from the baby’s air passages, to help it breathe?”

  Edgerton inclined his head. “Could be.”

  “In any of those alternative scenarios, is the mother of the infant causing it harm?”

  “No, she is not.”

  Ellie crossed to the jury box. “You mentioned that the cultures were contaminated?”

  “Yes. The lapse of time between the birth and the recovery of the placental tissue made it a culture plate, picking up bacteria.”

  “The fetal tissue was also contaminated?”

  “That’s correct,” Dr. Edgerton said. “By diphtheroids.”

  “On what did you base your identification of these . . . diphtheroids?” Ellie asked.

  “Colony and Gram’s stain morphology of the placental and fetal cultures.”

  “Did you do any biochemical studies to make sure they were diphtheroids?”

  “No need to.” The doctor shrugged. “Do you reread your textbooks before every case, Ms. Hathaway? I’ve been doing this for fifteen years. Believe me, I know what diphtheroids look like.”

  “You’re a hundred percent sure these were diphtheroids?” Ellie pressed.

  “Yes, I am.”

  Ellie smiled slightly. “You also mentioned that the placenta showed signs of acute chorioamnionitis. Isn’t it true that chorioamnionitis can lead a fetus to aspirate infected amniotic fluid, and thus develop intrauterine pneumonia—which in turn leads to septicemia and death?”

  “Very, very rarely.”

  “But it does happen?”

  The medical examiner sighed. “Yes, but it’s a real stretch. It’s far more realistic to point to the chorioamnionitis for premature delivery, rather than cause of death.”

  “Yet by your own admission,” Ellie said, “the autopsy revealed evidence of early pneumonia.”

  “That’s true, but not severe enough to lead to mortality.”

  “According to the autopsy report, meconium was found in the air spaces in the lungs. Isn’t that a sign of fetal distress?”

  “Yes, in that the fetal stool—the meconium—was passed into the amniotic fluid and breathed into the lungs. It’s very irritating and can compromise respiration.”

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