Page 71 of Pretty Broken Dolls

“Wouldn’t she bleed to death?”

“Slowly, unless of course the carotid artery was cut, but in this case, it wasn’t. Now look at this photo.” He showed a view of the victim’s chest, which had extreme darkened bluish-purple bruising, the heaviest being on the left side.

“She had been impaled on the wrought-iron fence. Wouldn’t that cause much of that bluish color?”

McGaven took a closer look, studying the photos as Dr. Dean continued his explanation.

“But, what is difficult to see is that the heaviest discoloration is on the left side of the chest almost precisely on top of the heart. It’s not common, but it is possible to be struck with something on the area near the center of the heart’s left ventricle. It’s the lower left chamber of the heart.” He reached for a plastic heart from the shelf to demonstrate his hypothesis. “It’s called commotio cordis and it usually happens to young people playing sports—being hit by a baseball or a fist.”

Katie and McGaven were both captivated by his explanation. It changed the crime scene dynamics.

“You see, for the blow to the chest to have killed her, it would have had to be during the precise moment of a heartbeat and aimed near the center of the heart’s left ventricle. This can trigger ventricular tachycardia. It can cause your heart to stop for a short period of time—or cause a sudden cardiac arrest.”

“A heart attack,” said Katie.

“Precisely.”

“So she could have been having a heart attack, which is what killed her, but the slicing of the throat was secondary. She would have bled to death, but it was sped up by the heart attack. Am I correct?”

“Essentially, yes. If I were to write this autopsy report, it would have read: ‘cause of death—primary ventricular tachycardia and secondary hypovolemic shock or blood loss caused from a neck knife wound.’”

“What types of weapons could cause this strategic blow to the heart?”

Dr. Dean thought a moment. “Anything long and slender that could be administered in a jabbing or poking motion. There would have to be some force behind it.”

“Like a baseball bat or a heavy tool?” said McGaven.

“Yes. If it were someone that was a master at martial arts or another similar discipline, a fist or foot blow could do the same. But you would have to be quite accurate.”

Katie leaned back taking everything in the medical examiner had told them.

Dr. Dean shuffled through several papers. “I have nothing to compare with their toxicology reports, but it appears in order and states that nothing unusual was found in the victim’s system.”

“Thank you for taking the time to look over this. It was on the condition of the body that we wanted your attention and expertise the most.”

“Detectives, it’s always a pleasure. You make my job more interesting,” he said. “Now, if you will excuse me, I have bodies to tend to, and that includes one for your current investigation.”

“Oh, one more thing,” she said.

“Yes?”

“Would it be possible for you to look at two other cases, just the autopsy of the injuries to their chests?”

“Of course. Send them over and I’ll get back to you when I can.” He rose from his desk and was gone.

“What do you think?” she asked McGaven walking toward the door.

“It changes things a bit. I mean, the outcome would be the same but the opportunity and means differ. This type of injury is intentional and also shows that the killer has medical knowledge. This is a game changer.”

“I agree.”

“I know something is bothering you.”

“Why wouldn’t Campbell’s people have found this? Surely one of them would have caught it. I’m still somewhat skeptical about this case and why we were dragged into it.”

Katie’s cell phone vibrated as she received a text message from Denise at the department.

You have a package delivered from the army K9 training facility. I left it in your office.