Again, before Margaret could answer, Mei-Ling said, ‘They are loops of wire that are used to close the sternum after open chest surgery.’
Margaret inclined her head slightly. ‘You know your surgery, Miss Nien.’ And Mei-Ling blushed.
Margaret returned to a systematic examination of the internal organ systems, working her way through the remains of the pericardial sac and the various arteries and pulmonary vessels left by the removal of the heart. Suddenly she stopped as she uncovered the ends of what looked like two very small sutures of blue-coloured thread. She examined them for a moment, a frown of puzzlement on her face, and glanced at Dr Lan. His dark eyes gave no clue as to his thoughts.
The major pulmonary vessels each bear a knot of suture, appearing to be a monofilament polypropylene, approximately half an inch in length.
She detailed the missing lungs and sectioned the neck before moving down to the stomach and intestine, noting the absence of the liver, gallbladder and pancreas, finding nothing abnormal until she began pawing her way through the retroperitoneal fat to make sure that the kidneys really were absent. There she found further suture knots on the renal arteries, and for a moment lost her scalpel as it slipped through fingers made greasy by the fat.
The spleen is normal size, shape and position
… She stopped and thought about that for a moment.
The capsule is grey-purple and wrinkled. Sectioning reveals an oozing red-purple, autolytic cut surface with no recognisable follicular pattern.
She moved, then, down to the pubic area and said, ‘Virgin territory. No one’s been down here before us. At least, not with a scalpel.’ With the bladder exposed, she stuck a needle into it to try to draw out some fluid. None was forthcoming, and she made a small incision with her scalpel so that she could look inside. Satisfied that there was, indeed, a small amount of fluid there, she twisted the needle off the syringe and drew out about 10 cc of cloudy amber urine with the syringe alone, and handed it to an assistant for dispatch to the lab.
Now she cut out the bladder to expose the uterus which was pink-tan in colour, and shaped like an upside-down, flattened pear. At its lower end it opened into the cervix, a small tough ring which was pale tan in colour and shaped like the lips of a carp. ‘Looks like someone’s lost their mom,’ Margaret said grimly.
‘How can you tell?’ Li asked, peering more closely.
‘The cervix is normally round in nulliparous women – that is, a woman who hasn’t had kids. When a woman has had children, the cervix is stretched and takes on the shape of a fish mouth. Like a carp. See it?’
Li nodded. This woman had probably delivered a child who would never see her again, who might not even know what had become of his or her mother. It was too easy to forget that these slabs of rotting meat on a table had once been living human beings just like them.
Margaret pulled the body of the uterus up, away from the vagina, felt for the cervix and cut across the vagina just below, leaving a small cuff of vagina around it. The fallopian tubes with their attached ovaries were connected to the uterus at the opposite top corners. She smiled to herself and said, ‘I always see this picture of a kind of homely, faceless bald kid. See … ? His ears would be the tubes and ovaries, and the cervix would be where his neck is.’
If any of the others saw what she saw, they did not find it amusing, and there was an embarrassed silence. Margaret shrugged and sighed. People never recognised the need for some kind of relief from this constant exposure to death and decomposition, the ceaseless reminder of your own mortality. No matter how absurd, humour was at least some kind of escape. She caught Lan’s eye and for a moment there was a twinkle in it. ‘I took up smoking,’ he said. And only Margaret understood the allusion.
She turned back to the womb, removing the tubes and ovaries and serially sectioning each to ensure that they were normal. Then she took a long set of forceps and tried to slide them up through the cervix into the body of the womb. It was a trick she often employed, using the forceps as a guide for her knife so that she could draw it up through the womb and cut it neatly in half. But in this case, she was unable to slide the forceps in. She tutted with irritation, and when she had finally bivalved the uterus, saw that adhesions on the inside wall had scarred it closed.
The uterus is grossly unremarkable, with the exception of a two by one centimetre area of scarring of the endometrium.
‘What caused the scarring?’ Mei-Ling asked.
Margaret looked up briefly. ‘Who knows? Probably some complication during childbirth. It is not uncommon. Certainly not as the result of sexual abuse, if that’s what you’re thinking. There is no indication that this woman has been sexually abused in any way.’
One of the assistants held the head in place while the other cut through the top of the skull with an oscillating saw, allowing Margaret to ease out the brain.
The scalp, skull and dura are intact and free of trauma. The dura is thin and translucent. The brain is apparently symmetric, but softened and pale green with decompositional change. The convolutional pattern cannot be evaluated due to decomposition. Serial sectioning and palpation of the brain, brainstem and cerebellar material shows no gross evidence of haemorrhage or mass lesion.
‘So nobody smacked her over the head,’ Margaret said.
When she had completed her examination of the musculoskeletal system, and examined the x-rays, she moved away from the table, perspiration gathering in her eyes, and removed her mask and goggles with a sense of relief. Off came the gloves and the steel mesh that protected her non-cutting hand, and as she removed her shower cap, her hair, damp with sweat, fell free over her shoulders. Only then did her sense of vulnerability return, and she steeled herself to mask it.
‘Well … ?’ Li asked impatiently.
But she ignored him and turned to Dr Lan. ‘A few questions, Doctor, about your other autopsies.’ He nodded acquiescence. ‘Have you had the results of the urine tests back from toxicology yet?’
‘They came in this morning.’
‘Did the lab do a gas chromatography urine acidic drug screen?’
‘They did.’
‘And did they by any chance detect traces of succinic acid?’
Lan stared at her for a moment, a frown of confusion or perhaps disbelief was etched on his brow. ‘How did you know that?’ he asked.
‘And a benzodiazepine?’
Lan was astonished now. ‘Well … yes.’
‘In both victims?’
‘But, Doctor, how can you––?’
She raised a hand to cut him off. ‘Bear with me, I’m indulging in some intelligent guesswork here,’ she said. ‘It could save us some time.’ She thought for a moment. ‘I would suggest a search for succinylcholine in the brain tissue, and that we get the lab to do a mass spectrograph of the urine to confirm the possible presence of midazolam.’ She stripped off her apron and gown and crossed to the sink to wash her hands.
‘Well?’ Li asked.
‘Well what?’
‘What do you think?’
Margaret looked at Lan. ‘I think we should re-autopsy the first two victims, don’t you, Doctor?’ And she added quickly, before he was forced to lose face, ‘We very often see what we expect to see, and when the bodies have been in the ground and decomposed to this degree … well, I think comparisons would be invaluable.’ He nodded, aware of her consideration, and grateful for it.
‘Do you wish to conduct all the autopsies?’ he asked.
‘No.’ She shook her head. ‘It would be far too much for one person.’ She flicked her head towards the camera on the wall. ‘I presume we had an audience. Your people?’ He acknowledged with an almost indiscernible nod. ‘Then they’ll know what to look for. Pick your best pathologists and we’ll share the load. If you’ll permit me to supervise, we could have them all done by tomorrow night.’ She dried her hands on a towel. ‘Now, I could do with a coffee.’
*
They sat in a room at the end of an upstairs corridor. White leather settees on a polished wooden floor, brown curtains drawn on large windows. Two monitors set on tables pushed against a half-panelled wall showed camera-eye views of the autopsy rooms downstairs. The viewing room was still filled with the cigarette smoke of the pathologists who had watched Margaret at work. She sipped on a mug of hot green tea as the leaves rehydrated and sank to the bottom. She had forgotten that the Chinese rarely, if ever, drank coffee, and she could have done with a caffeine hit right now.
Li and Mei-Ling, and Lan and the forensics officer, sat sipping tea also, and watching her expectantly.
‘Okay,’ Margaret said. ‘What do we know?’ She drew a deep breath. ‘We know that she was an Asian woman, probably in her early thirties. We know that she was probably the mother of one or more children.’ She tilted her head slightly towards Mei-Ling. ‘Although with the enforcement of the One Child Policy, no doubt just the one.’ Mei-Ling did not react, fixing Margaret instead with a long, cold stare. Margaret continued, unaffected, ‘I would hazard a guess that she might have been a seamstress or a tailor’s assistant.’ And she took pleasure in seeing a frown furl Mei-Ling’s brow.
‘How do you know that?’ Li asked, astonished.
‘There were tiny grooves on the occlusal surfaces of her front teeth. The kind of grooves that might be worn over many years of holding pins between them, as a seamstress does when she’s pinning a pattern or fitting pieces on a tailor’s dummy. I’ve often seen grooves like them, only bigger, in the teeth of joiners, where they hold nails between the incisors.’
There was a small gasp from Dr Lan. ‘Of course,’ he said. ‘The callus above the knuckle at the top of the middle finger. It would be caused by a sewing ring.’
‘A sewing ring?’ Margaret asked. ‘You mean a thimble?’
‘Not a thimble. In China a seamstress wears a ring at the top of her third finger to protect it as she pushes the needle through the material. It often leaves a callus, like a normal ring does at the root of the finger.’
‘Which makes it just about conclusive, then,’ Margaret said. ‘This woman almost certainly worked in the rag trade.’ She paused and chose her next words with care. ‘What I cannot say with any certainty is whether or not the poor woman had been experimented on by medical students or researchers …’ This to let Lan off the hook. ‘But I can say with absolute certainty that she was not the subject of a post-mortem.’
Li frowned and glanced at Dr Lan. ‘But I understood Dr Lan to have concluded that all these women had had autopsies performed on them.’
Margaret said, ‘Dr Lan was not entirely incorrect in that conclusion, Deputy Section Chief. The difference is that the woman I examined this morning had had an
ante
-, as opposed to a
post
-, mortem performed on her. In other words, she was very much alive when they cut her open.’ She looked at Lan. ‘Am I right, Doctor?’
He nodded gravely.
‘How do you know?’ Mei-Ling asked.
‘The yellow-brown colour of the skin around the long central wound. Caused probably by betadine, an iodine tincture used to disinfect the skin before making an incision. You don’t need to disinfect the skin of a dead person.’
‘And that is conclusive?’ asked Li.
‘No. But there were plenty of other clues. There was blood clotting around the chest and abdominal wounds. Doesn’t happen if the person’s dead. Also, the black gritty material I described along the incision edges was caused by an electrocautery device used to heat-seal small bleeders that aren’t big enough to suture. Miss Nien made the point herself when she described to you why the wounds were bloodless where the limbs and head had been severed. The woman was certainly dead when they hacked her up.’ She took a sip of her tea. ‘And then there were those sutures inside, tying off bleeding arteries where organs had been removed. Like I said, dead people don’t bleed.’
Mei-Ling flicked her hair back from her face and said, ‘You mentioned something about succinic acid and midazolam found in the urine.’
Margaret nodded. ‘I’m pretty sure the lab will find succinylcholine in the brain tissue. I would suspect that it was used, in conjunction with the midazolam, to keep the victims compliant. The midazolam sedates. It is often used in the induction phase of anaesthesia. It would need to be injected in small doses every few minutes to keep the victim riding on the edge of unconsciousness. The succinylcholine is a neuromuscular blocker. It would have paralysed the victims so that an ambu bag would have been required to force air into the lungs and keep the blood oxygenated. It sounds complicated, but it’s quicker and easier to apply than full anaesthesia.’
There was a long silence as everyone in the room took in the implications of Margaret’s findings. Eventually Li said, ‘It looks like I am going to have to revise my initial thoughts on organ theft.’
Margaret frowned. ‘What were those?’
Li said, ‘The reason I was brought in on this case is because of a body we found in Beijing last winter. A young woman, cut open and then dismembered. Identical in almost every detail to the Shanghai victims. I dismissed the thought that she might have been murdered for her organs because, although they had been removed, they were found with the body in a separate bag.’
Margaret shook her head. ‘I don’t think you can look for a motive in organ theft.’
‘Why not?’
‘Well, for a start the lady I examined today appeared to me to have had a partial autopsy performed on her, albeit a “live” one. And, as you know, the organs are always removed during autopsy to be sectioned.’
‘Why would anyone want to perform a “live” autopsy?’ Mei-Ling asked.
‘I have no idea. But it certainly helps to establish cause of death. After all, if you remove someone’s heart it is going to kill them. So the victim would die halfway through the procedure. Perhaps that’s why the ante-mortem was not completed, why the spleen and the lower organs were left intact. Who knows?’ She looked around the faces watching her, hanging on her every word, her every thought. ‘But more compelling still,’ she said, ‘there would be no need to keep someone alive in order to remove their organs for transplant. You would simply kill them and remove the organs afterwards. Cleaner, quicker, easier. I cannot think of a single reason why you would want to keep the person alive.’ She took another gulp of her tea. ‘The facts are these. Our seamstress was murdered by sterile surgical procedure. Her legs, arms and head were then crudely hacked off with some kind of heavy chopping instrument. The pieces were stored in a freezer for at least three months, and then dumped across the river anything up to a week ago, the process of thawing having increased the rate of decomposition. These are the facts. And other than indulging in wild speculation about it being the work of some kind of psycho surgeon, I’m afraid I can’t offer you a single clue as to why.’