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I t was close to four p.m. when Livia completed the autopsy.

Rounds in the cage had been running for an hour.

Currently, she was both tardy and ill prepared, and Livia had seen the consequences of wearing these qualities into the cage.

An unexcused absence bore less wrath than a poor performance, so in lieu of rounds Livia dropped off her specimens for further analysis by the dental- and derm-path labs, then picked up the X-rays she had ordered and headed upstairs.

She skated past the cage, where the lights were dimmed and Jen Tilly was presenting.

Dr. Colt and the other attendings had their backs to the entrance and their attention trained on the screen, making possible Livia’s stealth escape behind them.

She took the stairs to the second floor, where the neuropathology lab was located, and found Maggie Larson behind her desk and busy with paperwork.

Dr. Larson ran all things in the Office of the Chief Medical Examiner that dealt with brains. She had a single neuropath fellow assigned to her for the year, who was likely down in the cage listening to Jen Tilly.

“Dr. Larson?” Livia said from the doorway .

“Livia,” Dr. Larson said, eyes squinted. “No rounds this afternoon?”

“They’re going on right now but I was assigned an afternoon case and I need some help before I get murdered down there.”

Dr. Larson lifted her chin, noticing the transport container Livia carried by her side like a pail of water.

“What’ve you got?”

The woman had a sixth sense for brain tissue, and Livia and the other fellows knew a conversation could not be had with Dr. Larson if an unanalyzed brain was nearby. It was like trying to talk to a dog while holding a bone-shaped biscuit.

“I’m confused by something I found on exam and was hoping to get your opinion.”

Dr. Larson stood from her desk and pointed to the examining table.

A short woman whose hair had long ago sprouted gray roots and was now marble-streaked with the few dark strands that refused to give way, Margaret Larson held a PhD as well as a medical degree, which told Livia she’d spent years in paperwork and research labs.

Livia placed the container down as Dr. Larson clicked on the overhead lamp.

“What do we have?”

They snapped on latex gloves as they gathered around the table, Dr. Larson stepping onto a stool to gain height over the specimen.

“The investigators brought in a supposed floater found by fishermen this morning. From external exam, I know the body wasn’t floating.” Livia took the brain out of the container and placed it on the table, dripping the pungent formalin solution along with it .

“While examining the skull, I found this.” Livia handed Dr. Larson the autopsy photos of the skull piercings.

With no hesitation, Dr. Larson juxtaposed the photo next to the brain. She stuck her gloved pinkie finger into one of the holes in the brain tissue.

“I was thinking maybe pellet wounds from a shotgun blast, but could find no foreign bodies.”

Without talking, Dr. Larson grabbed her slicing knife—which looked much like a long, serrated bread knife—and began cutting the brain into one-inch sagittal sections.

She made it through, end to end, like a seasoned chef on a reality cooking show.

Livia watched the slices fall to the side, soupy and wet and old.

Dr. Larson inspected each of the sections.

“No pellets. And the pattern isn’t quite right for a shotgun blast. You’d see more randomness, and the angle of the pellets could come from only one direction.

” She pointed back to the autopsy photo.

“See here? This set of holes is temporally located over the ear; this other set is located more posteriorly. Pellets from a shotgun can only go straight, they can’t curve. ”

Dr. Larson looked at Livia to make sure she understood. Livia nodded.

“X-ray?” Dr. Larson asked.

Livia pulled black-and-white scans from a manila envelope, which Dr. Larson held up to the light. “No foreign bodies in the brain, so let’s move on from the shotgun theory. What else?”

“Infection was my other guess,” Livia said, knowing it was incorrect but wanting confirmation from Dr. Larson, as she was sure Dr. Colt would request .

“No peripheral or collateral melting or bone loss,” Dr. Larson said, looking back at the X-rays and the autopsy photos of the skull. “What else?”

Livia shook her head. “Congenital?”

Dr. Larson shook her head. “Doesn’t explain the concurrent piercings into the brain.”

“I’m out of theories.”

“That’s not enough ammunition for the cage.”

“Agreed,” Livia said. “Any suggestions?”

“Not from this. I’ll need to have a look at the skull. Get my hands on it. But one thing I can tell you: He didn’t die recently. The brain is soft and the decomposition is from more than water penetration.”

“The dermis was ninety percent eroded,” Livia said. “How long do you think?”

“Muscle mass?”

“Full and complete, not much erosion. Ligament and cartilage present throughout.”

Dr. Larson held up a sagittal section of the brain, placed it flat on her gloved palm. “I’d say a year. Maybe more.”

Livia cocked her head. “Really? Would the body last that long underwater?”

“In the condition you’re describing? Definitely not.”

Dr. Larson waited for Livia to piece it together. Finally, Livia lifted her gaze to meet Dr. Larson’s. “Someone sunk him after he was dead awhile.”

“Possibly. Any clothing on the body?”

“Sweatshirt and jeans. I put them in the locker as evidence. ”

“Smart girl. I’ll go examine the skull, see what I come up with. You might think about involving Dr. Colt.”

Livia nodded. “I’ll head down and let him know.”

* * *

When Livia entered the autopsy suite with Dr. Colt twenty minutes later, Dr. Larson had the body out of the cooler and was examining the piercings in the skull.

“Maggie,” Dr. Colt said. “I hear we have a complicated case.”

“Intriguing, for sure,” Maggie Larson said through her surgical mask as she stood over the body. She wore loupes that magnified the area of the skull she was interested in. Dr. Colt snapped on latex gloves, tied his mask, and went straight to the broken leg.

“This is not the fracture of a bridge jumper.”

“No, sir,” Livia said.

“Did you measure the height?”

“Femoral shaft fracture, twenty-seven inches from the heel,” Livia said.

“Make sure to include that number in your autopsy report. Homicide will want to compare that to the height of various car bumpers, since I’m quite certain this fracture is from a vehicle-to-man impact.”

Livia filed several things away in her mind.

First, to include the height of the leg fracture in this report, and all subsequent ones.

Second, horizontal femoral fractures can be caused when a car strikes a standing pedestrian, an impressive conclusion had she come up with it herself.

And last, to research other vehicle-to- man traumas so that she never again made the same glaring omission in an autopsy report.

“Got it,” Livia said.

Dr. Colt moved to the abdomen. “Broken ribs?”

“None. And the body was so decomposed, there’s no way it was floating. Abdominal cavity wasn’t able to hold gases.”

“What did the investigators’ report state?”

“Floater, but I believe that was based on the statement of the fisherman who found the body. I think he likely snagged the body off the bottom, hauled it to the surface, and called the police when he saw his catch. The investigators took the word of the cops and the fishermen that the body was floating. Plus, they noticed the broken leg and made the conclusion he was a jumper.”

“So you think he drowned?”

Livia shook her head. “No water in the lungs.”

“So peculiar,” Maggie Larson said from the top of the table. Cradling the skull in one hand while peering through her magnifying lenses, she probed the holes with an instrument Livia had never before seen in the autopsy suite.

Dr. Colt moved to the front of the table and took a spot next to Dr. Larson. “What do we have?”

“Twelve random holes through the skull.”

Dr. Larson extracted the probe she had been roto-rooting through the skull and set it to the side.

Livia looked closer and swore the foreign tool was a skewer she’d find in her kitchen drawer.

In her two months of fellowship she’d learned that MEs regularly brought personal tools to the morgue, whatever was most comfortable and got the job done .

“Too random to be gunshot pellets, and on different planes. Plus, no foreign bodies found.”

“Drill holes?” Dr. Colt asked.

Maggie Larson pouted her lips. “Morbid, but possible.”

Dr. Larson backed away from the skull and allowed Dr. Colt to take her spot.

He, too, pulled surgical loupes from his overstuffed breast pocket and slid them onto his face.

He was quiet for several seconds before he let out his characteristic “hmm . ” Finally, Dr. Colt removed his loupes and dropped them back into his jacket pocket.

He snapped off his gloves and rubber-band shot them into a garbage can across the room.

“Penetrating wounds of unknown etiology through the skull and dura and into the brain. Looking at the rest of the body and with Livia’s autopsy findings, he bled to death from these wounds.

The inside lining of the skull is remarkable for left side blood-staining, indicating the victim never moved from a supine position after suffering these wounds.

Put those conclusions in your report as well, Dr. Cutty.

Make sure it’s detailed. Keep the cause of death as exsanguination. Manner, undetermined.”

“Undetermined?” Livia said. “I thought we were on the same page that this was a homicide.” Livia felt her bragging rights slipping away.

The fellows fought each morning for the most interesting cases.

A homicide was by far the best any of them had seen in their first two months.

“Someone hit this guy with their car, and then . . .” Livia looked at Dr. Larson.

“Drilled him in the head, or something. Dropped him in the bay when they were done with him.”

“We provide the facts, Dr. Cutty. The detectives sort them out. ‘Or something’ is not part of our survey or our vocabulary. Get his clothing to ballistics for analysis.”

Livia nodded.

“You did good work, Livia,” Dr. Colt said. “Sometimes, the findings point a strong finger at what exactly happened. Other times, they simply tell us what did not. This guy did not jump from any bridge, that’s what we know for sure. The rest is out of our hands.”