Page 44 of The Couple’s Secret (Detective Josie Quinn #23)

Forty

With Gretchen in tow, Josie pushed her way through the doors to the morgue, feeling all the residual joy from the evening before drain away.

Her face still hurt from laughing. Shannon’s picture game had been a smashing success.

By the time Josie slipped into bed next to Noah, she was high on having watched Wren laugh and smile so easily and so many times.

For the first time in months, hope bubbled from somewhere deep inside her.

As she spied the single occupied autopsy table, guilt smothered that burgeoning feeling of happiness.

Those wonderful H feelings didn’t belong here.

A sheet covered Riley Stevens’ body up to her shoulders.

Her strawberry-blonde hair was lank, as though death had robbed it of its sheen.

A stab of sorrow pierced Josie’s heart. What would Riley’s life have been like if Cora hadn’t been killed?

If seven long years of not knowing hadn’t passed, compounding her stress and sense of loss?

If she’d just been a normal, carefree twenty-three-year-old?

If her mother had still been in her life, would she have turned to alcohol so readily?

The never-knows were endless. Wherever there was loss, they were right beside it, driving the living to the brink of insanity.

Across the room, Gretchen knocked on the door to Anya’s office, calling for her.

It had been three days since Riley’s death.

The number of reporters stationed all over the city—at Riley’s home, at Hollis’s office, and at the police station—had tripled.

At this point, Josie was beginning to associate the outdoors with questions being shouted at her.

The Mayor had made an appearance at the stationhouse just yesterday, passive-aggressively criticizing their work ethic and their intelligence and putting the Chief in such a foul mood that even Turner chose not to provoke him.

Anya sailed into the examination room, her silver-blonde hair loose around her shoulders and a frown on her face. “Sorry. I was doing some research. Had to call a colleague of mine in Philadelphia.”

Gretchen said, “In connection with Riley Stevens?”

“Yes.” Anya stopped near the table, glancing at Riley’s face. She put her hands on her hips and blew out a breath. “God, I hate it when they’re this young.”

“So do we,” Josie said.

“Let’s get to it then.” All business now, Anya slowly folded the sheet down, exposing Riley’s torso, stopping just below her hip bones.

“No signs of sexual assault. On autopsy there was evidence of cerebral edema—an excess of fluid in the brain tissue. However, I didn’t find any areas that suggested cerebral infarcts which are basically showing tissue death, which I’d expect to see if she’d had a stroke.

No evidence of an infection, traumatic brain injury.

No tumors. She also had pulmonary edema. ”

“Fluid in her lungs,” said Gretchen.

“Yes,” Anya replied. “But what I didn’t see was visible damage to the heart, although the lab will do a host of histological tests.”

“That’s when they look at tissue samples under the microscope, right?” Josie asked.

“Right. But like I said, there were no abnormalities of the pericardium, blockages in the vessels, or damage to the heart muscle. She may have had a cardiac arrest, which is different from a heart attack. Cardiac arrest occurs when there’s a disruption in the heart’s electrical system.

It’s usually the result of an arrythmia.

Problems with the heart’s conduction system are not something that would be visible during an autopsy.

There is genetic testing that can be done for inherited cardiac conditions, but those take time. ”

“What about alcohol poisoning?” Josie asked.

“There were no findings consistent with that. In terms of her alcohol consumption on the day she died, we have to wait for toxicology results, which as you know, can take at least six weeks, sometimes longer. Do keep in mind though that postmortem blood alcohol concentration can be very unreliable. The rest of my findings on autopsy were unremarkable.”

Gretchen sighed. “What are we dealing with here? I know you can’t give a complete picture without toxicology, but do you have some initial thoughts?”

One of Anya’s brows shot up. “Do I ever. I was extremely suspicious given the fact that her death came so soon after her mother and Tobias Lachlan’s bodies were found, the brutality of those murders, and the lengths their killer went to to ensure they were never found at all.

The final red flag was the two injection sites on her left hip I found on external exam. ”

Josie felt a jolt through her system like she’d just mainlined three shots of espresso. Beside her, she sensed Gretchen’s body go rigid.

Neither of them spoke, instead watching with bated breath as Anya moved the sheet down a few inches more.

Riley had been curvy, her hips full. Anya pointed to the fleshiest part of her left hip, just below a thick set of sutures from the autopsy.

Two almost imperceptible pink dots were visible, about an inch apart from each other.

They looked very different from the punctures on Riley’s palm.

“Subcutaneous injections,” Anya said. “Fresh, by the looks of them. Her husband said she didn’t have any medical conditions.

Toxicology takes weeks, months sometimes.

I was reviewing what substances she could have been injected with subcutaneously.

There are a lot. One of them I was able to do some initial testing for here, using immunohistochemistry staining. ”

“Immuno-what?” Gretchen said.

“Immunohistochemistry. It’s a way to detect antigens in a tissue sample.” Anya pointed to the sutures near the injection marks. “Using samples of adipose tissue—body fat—from various levels beneath the wound sites to see antigens.”

“Which are?” Josie asked.

“Any substance that sets off an immune response in your body. Basically, they’re possibly harmful or foreign and your immune system kicks in, creating antibodies to fight them.

With immunohistochemistry, we can stain the sample using antibodies.

They will only bind to very specific antigens which tell us what substance started the reaction.

That’s a very, very simplified explanation. ”

Gretchen put up a palm. “That’s good enough for us.”

Anya smiled. “Then I won’t bore you with any more details. Like I said, I had to call a friend of mine in Philadelphia to make sure I was doing it correctly. The process takes about twenty-four hours and it will have to be repeated by the state lab for confirmation.”

Moving away from the table, she waved them over to the long stainless-steel countertop at the back of the room. A slide had been preloaded onto a small, blocky white microscope. “Have a look.”

Josie went first. All she could see was a film of white and a color that straddled the line between bright pink and light purple. Darker pinpricks of that same indefinable color dotted the field of vision. Then there was a blotch that looked brownish-yellow.

Straightening, Josie let Gretchen have a look. “I’m guessing the ugly splotch that doesn’t match anything else is the issue? The antigen?”

Anya laughed. “Yes. Those brownish-yellow granules that you see in the cytoplasm? They’re positive cells.”

“Positive for what?” asked Gretchen.

“Insulin.”

Josie and Gretchen stared at her. “Insulin,” Gretchen repeated slowly.

“Given Riley’s history of having no significant medical conditions or issues, together with the circumstances surrounding her death, the findings of cerebral and pulmonary edema and the injection sites, I decided to check.

It can also be confirmed via toxicology, but this was the fastest way for me to figure out if my hunch was correct. ”

“That she was poisoned with insulin?” Josie felt that strange mix of adrenaline and dread spreading through her system like a bad drug.

“I believe so,” Anya replied. “Although I cannot make anything official until I’ve got all the lab results.

Everything I’ve just told you is consistent with that possibility though.

Riley Stevens was injected with insulin twice before her death.

In high doses in someone who isn’t insulin-dependent, it can cause severe hypoglycemia.

Her blood glucose levels would have dropped to dangerous levels.

She may have experienced confusion, disorientation, nausea, slurred speech, blurred vision, loss of consciousness.

There are studies that have shown that severe hypoglycemia can cause cerebral and pulmonary edema, even arrythmias and sudden death.

There are a lot of variables that come into play since we don’t know what type of insulin or the dosage.

Two injections may or may not have been enough to kill her but combined with a high level of alcohol, it most certainly could have been fatal. ”

“If you’re right, that means the manner of death is homicide,” Josie said.

“As I said, the lab will need to confirm my findings, but I can’t think of any scenario in which Riley Stevens would inject herself with insulin twice.

Especially in her hip. Most diabetics give themselves injections into the abdomen, buttocks, thighs, or sometimes upper arms. The fatty tissue allows for slow and consistent absorption of the insulin. ”

Gretchen said, “Surely she wouldn’t have injected herself as a way to take her own life.”

“I can’t comment on her mental state,” Anya said. “The question for you two is how someone else would inject her without her knowing about it or trying to fight it off.”

“She might have been drunk,” Josie pointed out. “Maybe she was just too out of it to notice or care. Anya, if someone had injected her with a fatal or near-fatal level of insulin, how long would it have taken for her to die?”

“Without knowing the specific concentration of the insulin or her blood alcohol concentration, it’s difficult to tell. It could have been hours or minutes.”

“Minutes,” Josie murmured.

Had someone joined her at the boat ramp?

Denton PD had tracked the phones and vehicle infotainment centers—which gave GPS coordinates—of Hollis, Jackson, and Zane.

None of them had been near the boat ramp that morning.

In fact, the data from their phones and cars matched their statements.

The most logical explanation was that Riley was injected at Hollis’s house before she left for the boat ramp.

Perhaps she hadn’t started drinking until she got there and the alcohol, combined with the insulin, tipped her over the edge.

“Well, we know where the insulin came from,” Gretchen said. “Hollis.”

Josie nodded. “The first time we met Hollis, his sister told him he needed to keep his blood sugar under control or he wouldn’t be eligible for a pump.”

Anya leaned against the counter, folding her arms across her chest. “An insulin pump. He may be type 1, then, and if he doesn’t have a pump, he’s using insulin pens.”

They’d need a warrant for Hollis’s home. Possibly the At Your Disposal office. Whichever pharmacy he used to get his insulin pens. He’d have to be brought in for a formal interview. So would Jackson and Zane.

All three of them had had access to insulin and the opportunity to use it.