"It would be way low on my list," Latasha said. "The history pretty much rules it out, you know what I'm saying?"
"I'm with you," Jack said. He handed Latasha a scalpel. "How about you do the honors."
Latasha made the typical Y incision from the points of the shoulders to the midline and then down to the pubis. The tissue was dry like an overcooked turkey with a grayish-tan color. There was no putrefaction, so the smell was fusty but not offensive.
Working quickly and in tandem, Jack and Latasha had the internal organs exposed. The intestines had been completely evacuated with the embalming cannula. Jack lifted the firm edge of the liver. Beneath and affixed to its underside was the gallbladder. He palpated it with his fingers.
"We have bile," he said happily. "That will help with the toxicology."
"We've got vitreous as well," Latasha said, palpating the eyes through the closed lids. I think we should also take a sample of that."
"Absolutely," Jack said. "And urine, too, if we can get it from either the bladder or kidneys."
Each took syringes and took the samples. Jack labeled his while Latasha did the same with hers.
"Let's see if there's an obvious right-to-left shunt," Jack said. "I keep thinking the cyanosis issue is going to prove important."
Carefully, Jack eased away the friable lungs to get a look at the great vessels. After a careful palpation, he shook his head. "Everything looks normal."
"The pathology is going to be in the heart," Latasha said with conviction.
"I think you are right," Jack agreed. He called Bill over and asked if there were any stainless pans or bowls they could use for the organs. Bill produced several from a cabinet below the embalming-room sink.
Proceeding as if they were accustomed to working together, Jack and Latasha removed the heart and lungs en bloc. While she held the pan, Jack lifted the specimen out of the chest and placed it inside. She put the pan down on the table beyond Patience's feet.
"Lungs look normal," Jack said. He rubbed his fingers over the lungs' surface.
"They feel normal, too," Latasha said as she gently prodded them in a few locations. "Too bad we don't have a scale."
Jack called Bill over and asked if a scale was available, but it wasn't.
"The weight feels normal to me," Jack said, hefting the block of tissue.
Latasha tried it but shook her head. "I'm not good at judging weights."
"I'm eager to get to the heart, but maybe we should first do the rest. What do you say?"
"Work first, play later: Is that your motto?"
"Something like that," Jack said. "Let's divide the job to speed things up. One of us could do the abdominal organs while the other does the neck dissection. For completeness' sake, I want to make sure the hyoid bone is intact, even though neither of us thinks strangulation was involved."
"If you are giving me a choice, I'll do the neck."
"You're on."
For the next half-hour they worked silently in their respective areas. Jack used the sink to wash out the intestines. It was in the large intestine that he found the first significant pathology. He called Latasha over and pointed. It was a cancer in the ascending colon.
"It's small, but it looks like it penetrated the wall," Latasha said.
"I think it has," Jack agreed. "And some of the abdominal nodes are enlarged. This is dramatic proof that hypochondriacs do get sick."
"Would that have been picked up by a bowel study?"
"Undoubtedly. If she'd had one. It's in Craig's records that she continually refused his recommendation to do it."
"So it would have killed her if she didn't have the heart attack."
"Eventually" Jack said. "How are you doing with the neck?"
"I'm about done. The hyoid is intact."
"Good! Why don't you get the brain out while I finish up with the abdomen? We're making excellent time." Jack glanced up at the wall clock. It was closing in on eight p.m., and his stomach was growling. "Are you going to take me up on the dinner offer?" he called to Latasha, who was on her way back to the table.
"Let's see what time it is when we finish," she called back over he shoulder.
Jack found a number of polyps throughout Patience's large intestine. When he was finished with the gut, he returned it to the abdominal cavity. "I do have to give Harold Langley credit. His job with Patience Stanhope would have made an ancient Egyptian embalmer proud."
"I don't have much experience with embalmed bodies, but the condition of this one is better than I expected," Latasha said as she plugged in the bone saw. It was a vibrating device designed to cut through hard bone but not soft tissue. She gave it a try. It produced a high-pitched whirring noise. She positioned herself at the head of the table and went to work on the cranium, which she had previously exposed by reflecting Patience's scalp down over her face.
Relatively immune to the racket, Jack palpated the liver, looking for metastases from the cancer in the colon. Not finding any, he made a series of slices through the organ, but it was seemingly clear. He knew that he might find some microscopically, but that would have to be at a later date.
Twenty minutes later, after the brain had been cleared of gross abnormality and a number of specimens from various organs were taken, the two pathologists turned their attention to the heart. Jack had cut away the lungs, so it was sitting in the pan by itself.
"It's like saving the best present for last," Jack said while gazing eagerly and intriguingly at the organ and wondering what secrets it was about to reveal. The size was about that of a large orange. The color of the muscle tissue was gray, but the greasy cap of adipose tissue was light tan.
"It's going to be like dessert," Latasha said with equal enthusiasm.
"Standing here looking at this heart reminds me of a case I did about half a year ago. It was a woman who collapsed in Bloomingdale's and whose heart couldn't be paced by an external pacemaker, just like Patience Stanhope."
"What did you find on that case?"
"A marked developmental narrowing of the posterior descending coronary artery. Apparently, a small thrombosis knocked out a good portion of the heart's conduction system in one fell swoop."
"Is that what you expect to find on this case?"
"It's high on my list," Jack said. "But I also think there is going to be some kind of septal defect causing a right-to-left shunt to account for the cyanosis." Then he added parenthetically, "What it's not going to tell us, I'm afraid, is why someone was so intent on us not finding out whatever it is we are about to learn."
"I think we're going to find widespread coronary disease and evidence of a number of previous small, asymptomatic heart attacks so that her conduction system was particularly at risk prior to the final event, but not compromised enough to show up on a standard ECG."