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“If you’re here to talk about Casey, I’m gonna need one of these. Sure you don’t want nothin’?”

“Yes, thank you.” Livia looked around the small home. “You live here alone, Mrs. Delevan?”

“Call me Barb. Yeah, it’s just me. Alan down at the store thinks he lives here sometimes, till I set him straight.” She smiled to reveal a set of rickety teeth and necrotic gums.

Livia noticed a pack of Marlboros on the end table and had smelled the stale odor of nicotine as soon as she walked in the door. The last years of Livia’s life had been spent analyzing the lifeless human body, its tissue and cells, and witnessing the destructive nature of the world—the things the human race does to one another and to themselves, the substances that are ingested, the air that is breathed, and the manner in which our organs malfunction as a result of it all. The consequence of this education and the postmortems she’d conducted was that Dr. Livia Cutty saw death before it arrived.

She watched Barb take a gulp of vodka and Coke and imagined the fatty liver that sat inside the woman’sbody. Livia knew exactly what that organ would feel like in her hands, bloated and greasy with hardening vessels snaking along its surface, abused for so long by the toxins that washed through it. When Barb reached for the Marlboros and put one between her lips, pinching her lips together as she ignited the tobacco, Livia watched in her mind’s eye as the smoke traveled through the trachea and into the lungs. She imagined the epithelial cells and goblet cells lining the airway, streaked now with yellow soot and slowly dying. She saw the small bronchioles of Mrs. Delevan’s lungs already stenosed from years of abuse, and the tiny clusters of alveoli tight from necrosis and unable to expand and transfer oxygen into the bloodstream. Put this woman on a treadmill and Livia could see her heart working in overdrive to push oxygen into those dying lungs.

“You have one of those?” Barb asked. “A guy who thinks he can come and go as he pleases?”

“Can’t say I do, ma’am.”

Barb waved her hand to dismiss the thought. “You with the police?”

“No, not exactly. I’m with the Office of the Chief Medical Examiner in North Carolina. I was the one who performed the autopsy on your son.”

“Oh yeah? Cops said I could call you if I had any questions.” Mrs. Delevan turned and paged through the papers to her right, gave up after a minute. “They gave me a card, it’s in here somewhere.”

“Here,” Livia said, handing her a new one. “I’m always available.”

“You come all the way down from Raleigh?” Barb said, reading the card.

“Yes, ma’am.”

“Long way.”

“It was a pretty drive. Trees are starting to change,” Livia said. “And I don’t like talking to family over the phone about something so delicate.”

“Well, I appreciate it. Police tell me my Casey didn’t drown, that maybe somebody killed him.”

“Yes, ma’am. That’s what my examination revealed.”

“Somebody stabbed him, they said?”

Livia nodded. “That’s what it looks like, yes.”

Homicide detectives, Livia was learning, were notorious for leaving out “unimportant” details when talking to victim’s families. Livia could imagine the two Raleigh detectives setting foot in this home and knowing two things immediately. First, Barb Delevan had nothing to do with her son’s death. And second, she wasn’t going to be useful to their investigation. To streamline their visit, the detectives had left quiet the details about the suspected manner in which Casey Delevan had died. “Stabbed” carried the connotation of a sharp object to the gut. As awful as that image may be, unidentified holes to her son’s skull were worse.

Barb Delevan shook her head, took a sip of vodka and a long drag from her cigarette. “You sure he didn’t drown like the newspeople say? He wasn’t really stable. Mentally, I mean. I could see him jumping from that bridge before I could see him . . . well, before I could imagine someone hurting him.”

“I’m sure, ma’am. Your son did not drown.”

“But on the news, they say he might have.”

“I understand, but the newspeople have it wrong.”

“How can you tell?”

“Lots of ways. But the strongest evidence we have is that your son had no water in his lungs. This tells us without question that he did not drown. And he had no injuries consistent with a long fall from a bridge.”

“So it’s true? Someone stabbed him?”

Livia nodded and Casey’s mother wiped her eyes before taking another hit from her cigarette.

“He suffer?”

Livia had no way of knowing this. But based on Maggie Larson’s report that whatever was used to penetrate Casey Delevan’s head had breached the brain tissue as deep as an inch and a half in four different locations of the temporal lobe—responsible for hearing and cognitive ability—there was a very good possibility that Casey Delevan suffered a long, slow death while bleeding out and completely conscious. The only good news was that he might have been deaf and unable to comprehend what was happening. Then again, he might have lost consciousness, making his death truly painless. This long afterward it was simply impossible to know for certain. Still, Livia’s answer was immediate.