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T rouble sleeping the night before, with thoughts of Nicole and Casey Delevan running through her mind, Livia was at work early on Friday morning.

She finished paperwork in the fellows’ office until nine a.m., when she was due in the autopsy suite for morning rounds.

In front of her locker she pulled the blue smock over her scrubs and stuffed her hair under a surgical cap.

She entered the autopsy suite, dropped her surgical gloves and face shield onto the table, and walked over to the whiteboard where the day’s cases were labeled and assigned.

She saw her name scribbled in blue dry-erase:

The other fellows similarly had cases assigned to them, as did four of the attendings.

She read through the list to see if anyone had a more interesting assignment.

All the cases that morning looked mundane, except for Tim Schultz.

He had a gunshot wound, and Livia was unhappy about it.

She knew, however, with little sleep and her mind so firmly preoccupied with Nicole that today was not the right time to tackle a challenging case.

Or even an interesting one. An elderly fall victim felt appropriate for her current mindset.

“You look like shit,” Jen Tilly, one of the other fellows, said as she walked up to the whiteboard.

“Thank you,” Livia said.

“Were you crying?” Jen asked.

“No. Just up all night.”

“What’s wrong?”

Livia lifted her chin when Dr. Colt strolled into the morgue. “Long story.”

Tim Schultz jogged through the door just after Dr. Colt and hustled past him to the dry-erase board. Dr. Colt, with his hands behind his back, walked to the board and scrutinized it as if he hadn’t written every word an hour earlier.

“Late for morning rounds, Dr. Schultz, and you don’t get a case for that day.”

“Yes, sir,” Tim said.

“Cutting it close, no?”

“Had a bathroom emergency.”

“Um-hmm,” Dr. Colt said, still reading the board, head back and peering through his cheaters. “There are certain things I don’t need to know about my fellows, Dr. Schultz. You’ve just touched on one of them.”

Dr. Colt walked to the whiteboard, picked up the eraser, and wiped clean the assignment next to Tim Schultz’s name.

“That was a gunshot wound that might have been interesting, but I think I’ll give it to Dr. Baylor.

An overdose came in overnight, and with your stomach already sour, Dr. Schultz, I think that’s a better assignment for you. ”

Dr. Colt began writing on the whiteboard. Livia and Jen smiled while Tim turned his palms upward.

“Dr. Colt, my stomach feels just fine.”

“Not for long. The OD is a decomp found in the projects, suspected to be a week old, or more. The investigators should be wheeling him in soon.”

Tim looked over at Livia and Jen, who were doing their best not to laugh. He mouthed, without making a sound, I wasn’t late!

* * *

An hour into her autopsy of the elderly fall victim, Livia was struggling to get through the morning.

She had completed the external examination to discover ecchymosis on this eighty-nine-year-old woman’s left side, from her rib cage to her shoulder to her skull.

She noted and photographed a likely broken ulnar and radius on the left side.

The internal examination was unremarkable, as she suspected it would be, and Livia started the process of weighing the organs.

Today was the first time in her fellowship—the first time since her early days of path residency—when the smells and noises of the morgue bothered her.

Tim Schultz’s decomp arrived just as Livia was detaching the lower intestine from the rectum. As soon as the investigators unzipped the bag, the odor hit her as it wafted through the autopsy suite.

“Christ Almighty, Tim,” Livia said. “Turn on your overhead. ”

Tim switched on his ventilation fan as the investigators positioned the body on his table and quickly fled the morgue.

A few minutes later he sliced open the abdomen, releasing the noxious fumes of intestinal rot. The odor hit everyone in the morgue, and a collective sigh came from each of the doctors.

“Seriously, Tim,” Livia said. “Turn up your fan.”

“It’s on high, Cutty. Since when did you become so odor intolerant?”

Livia tried to block the smell from her mind as she went back to work.

The woman in front of her had been discovered yesterday afternoon by her son, who stopped by for his weekly visit and found her lying on the bathroom floor.

What Livia needed from this portion of the exam was a time of death, which she calculated from the stomach contents.

She noted lividity on the left side, which suggested the fall had likely rendered the victim unconscious since she hadn’t appeared to move after the incident.

Specifically, she hadn’t rolled onto her back as many fall victims tend to do.

Livia confirmed the fractured wristbones, and then moved to the skull, where she knew the full story would be told.

With the bone saw in her hands, she worked hard to ignore the mess that was unfolding on Tim Schultz’s table.

It reminded her of her own decomp from last month, and she tried desperately to stop thinking about Nicole smiling happily in that photo.

Livia tried not to think about Casey Delevan’s arm draped over her sister’s shoulder—the same arm she and Dr. Colt discovered to have suffered “shovel” wounds when someone dug him up.

She tried not to think of the abrasions on his wrists and ankles from cinder blocks that pulled him to the bottom of Emerson Bay.

With all these thoughts coursing through her mind, Livia’s movements were sticky and fat.

She moved the buzzing bone saw over her patient’s head and performed the ugliest craniotomy of her short career, forgetting to design the cut asymmetrically so the skullcap would fit back into place without sliding off.

Family members were never happy to see their loved one with a deformed skull at the funeral, a lesson every first-year pathology resident learned.

“Shit,” Livia said to herself as she switched off the bone saw and watched the skullcap slide off the top of her patient’s head.

Dr. Colt—standing at Tim Schultz’s table with his hands behind his back, cheaters on the tip of his nose, closely observing the internal exam—looked up. “Dr. Cutty? Is there a problem?”

Livia pushed the skull back into place. She’d now have to run thick sutures through the scalp and, if possible, place a few staples into the skull when she was finished.

“No, sir,” Livia said. Dr. Colt drew his attention back to Tim’s decomp.

When she let go of the skullcap, it sloughed back onto the autopsy table and Livia peeled away the dura.

She examined the brain and quickly documented the findings she knew would be present.

A subarachnoid hemorrhage with midline shift of the brain—very typical of head trauma when elderly people fall and are not fast enough or strong enough to break their descent.

Worried about the extra time she needed to suture the skull, Livia performed the neuro exam quickly, removing and weighing the brain, and then taking appropriate photographs for afternoon rounds.

With everything completed, she got busy putting the body back together.

Making the head presentable proved challenging and time-consuming.

When she finished—one hour and fifty-two minutes later—she was embarrassed by her work.

A mediocre technician could have done a better job pulling the Y-incision together, and the skull was simply a mess of running sutures and staples the mortician would have to make presentable.

Thankfully, Tim Schultz’s decomped overdose distracted Dr. Colt the entire morning.

* * *

With her paperwork completed, Livia created a zipped file of her fall victim’s case for afternoon rounds.

As soon as she finished, she sat at her desk and cruised the Internet, searching for anything she could find about Casey Delevan.

Pickings were slim as Mr. Delevan had little to no online presence aside from the fact that he was recently ID’d as the man fished from the bay at summer’s end.

“Well,” Tim said as he entered the fellows’ office. “That’s the last time I use the bathroom before morning rounds.”

Livia abandoned her search as Tim and Jen walked in.

“It’s been a while since Colt has doled out reprimands,” Jen said. “I think he was waiting for his first chance to stick it to one of us. Wrong time, wrong place.”

“No kidding,” Tim said. “That was the worst case I’ve seen.”

“Smelled like it,” Livia said .

“You’d better have your facts straight for rounds,” Jen said. “Your decomp is sure to get all the attention. And Colt is on a rampage.”

They worked through lunch and then made rotations through dermatopathology and neuropathology before meeting back in the cage for afternoon rounds.

Indeed, Tim’s case got much of Dr. Colt’s attention.

Tim spent a full hour in the front of the cage, albeit a calm sixty minutes where he successfully navigated the onslaught of questions.

Tim had made obvious progress since fellowship began in July, and was no doubt aided today by Dr. Colt having spent the entire morning at his table.