Autopsy Room B-3 was at the end of a long hallway. The last time Luke had been in a morgue was during medical school. At the time, he couldn’t fathom why anyone would choose this line of work. His opinion hadn’t changed. The room was about the size of a large dungeon, and filled with death. Seven stainless steel autopsy tables stretched out along its length, each with generous amounts of floor space around it. A large meat scale hung above the center of each table. Every work area had two water faucets, and one of the spigots on each countertop had a hose wrapped around it. At the far end of the room a long row of rubberized aprons hung from wooden hooks.
Four of the autopsy tables had occupants. Thick plastic sheets covered three of the naked corpses. The fourth was being disassembled by a pathologist or technician whose expression was as disinterested as his client’s.
As Jay led them into a meeting room at the far end of the autopsy lab, Luke asked, “Is the girl’s body still here?”
“No, no. It was interred several weeks ago.”
They took seats around a conference table.
“On the table in front of you are copies of our report,” Jay said. “I don’t know how much you know—”
“Just to be safe, assume we know nothing.” Ben grabbed the report and started thumbing through it.
“Then let’s start with a brief summary,” the M.E. began. “This is a Jane Doe case, a girl we estimate to have been about eight or nine years old, based on her bone age. The body was found just outside the entrance to a small hospital, on one of those frontage roads that runs along the Santa Ana Freeway.”
Jay handed a stack of eight-by-ten photographs to Ben. “Here are the pictures from the scene. Notice the way the body is propped up against a wall, in the sitting position. There were no signs of trauma, and it may be that whoever left her there was hoping someone would find her and take her into the hospital. Note the pattern of lividity — the blood had pooled on the underside of the buttocks and legs, the distal aspects of both arms, and the chin, which was bent forward and resting against the chest. All of this suggests to us—”
“That the girl was still alive when she was left there,” Ben broke in.
“Exactly. It’s anyone’s guess, but we think it may have been a coyote drop.”
Ben’s left eyebrow arched. “A what?”
“A smuggler that brings illegals across the border,” Luke explained.
“What tells you that she was an illegal?” Ben asked.
“Well, to begin with, she’s almost certainly not a U.S. citizen. Her clothing was made from a non fire-retardant weave that’s illegal in the US, and her underwear was stitched by hand with no elastic bands. I’m jumping ahead here, but she also had two intestinal parasites — ascariasis and trichuriasis — as well as widely disseminated trichinella cysts in her muscles. Of course, she could have picked up any one of those in the U.S., but all three? Not likely. She probably lived in a region endemic for those parasites.”
Luke said, “I don’t see how that gets you to the conclusion that a smuggler brought her across the border.”
“Just playing the odds,” Jay replied. “It’s rare that no one steps forward to claim the body of a young child, but we’ve had it happen with families that entered the country illegally, families that are afraid to go to the authorities.”
“Any idea where she was from?” Luke asked.
“Phenotypically, her facial contours suggest a fairly pure Indian lineage. Could be almost anywhere in Central or South America.”
Luke thought about Josue Chaca. “Any tattoos on the body?”
“As a matter of fact, yes,” Jay said. “On the lower abdomen, three small circles. We spoke with a forensic anthropologist about that. It’s described in the report.”
Ben handed Luke a picture of the corpse, then flipped through the pages of the report. “Here it is,” he said. “It says, ‘The location and gender suggest some kind of fertility symbol. These types of markings are occasionally seen among Mayan tribes in Guatemala, as well as Inca tribes in Peru and Ecuador.’ ”
Jay said, “Why do you ask about tattoos?”
“The boy I saw in our E.R.,” Luke said, “had one on the left side of his chest, shaped like a crescent moon.”
Ben was looking at the report. “I see that you looked for toxins.”
“Yes, but we found nothing. Serum analysis, tissue analysis, hair analysis — all negative. In fact, just about everything we’ve looked for has been a dead end. We know that the mechanism of death was asphyxia, but the disease or injury that caused the asphyxia is still a mystery.”
The medical examiner opened a folder of tissue slides and slid one into a projection device at the center of the table.
An image appeared on the screen. “The interesting findings were found on the microscopic exam — specifically, in the bone marrow, lungs, pancreas, and bile ducts. As you can see on this slide, the bone marrow is hyperproliferative, primarily lymphocytic precursors, and cellularity is very high — over ninety percent.”
“What does all that mean?” Luke asked.
“This marrow is unusual in several respects,” Jay said. “I’m still not sure what it is or what it means, but I can tell you what it isn’t. It’s not leukemia, and it’s not a toxin — at least, none that I’ve ever seen. It’s probably not an infection — viral, bacterial, and fungal cultures of the bone marrow were all negative.”
“You can’t test for everything,” Luke said. “There’ve got to be some toxins that aren’t included in your testing methods.”
“That’s always a possibility, but unlikely in this case. Let me show you a section of the lungs, and I think you’ll understand.” Jay removed one slide from the projector and replaced it with another. “This is a section of the upper airways, the trachea. As you can see, it’s virtually normal.” Again he changed slides. “Now we’re looking at—”
“I’ll be damned,” Ben whispered.
“—bronchioles in the lower airways of the lungs. The epithelial cells — see here? For the most part, they’re gone. They’re just not there.”
Ben shot a glance at Luke.
Jay aimed a laser pointer at a specific area on the slide. “Now, look here. There’s an overwhelming infiltration of white blood cells into the surrounding tissues, almost all lymphocytes. I didn’t believe it at first, so I took several additional sections of lung. Every section of lung looks like this.”
Ben leaned forward, grabbed an eyebrow and started playing with it. “That’s not artifact. That’s real.”
Jay nodded. “So Luke, getting back to your question about toxins, it’s difficult for me to imagine a toxin that would spare the upper airways and selectively attack the lower airways. It’s more likely that we’re dealing with a biological agent of some sort.”
“I assume you cultured the lung tissue?” Ben said.
“Yes. Lung cultures were all negative,” Jay said. “Except for the parasites that I already told you about, the only infectious organism we found was in her nasal secretions. It was a garden-variety rhinovirus.”
“This girl wasn’t killed by a head-cold virus,” Ben said.
Jay reached for another slide. “This next slide of the alveolar lung tissue—”
“Let me guess. The alveoli have cellular debris in them, but no specific damage.”
“How did you know that?”
“It doesn’t take a genius to spot a goat in a flock of sheep. This is a carbon copy of our boy’s lungs. Tell us about the pancreas.”
“It’s equally impressive.” Jay slipped another slide into place. “This is a high-magnification view of the pancreas. There’s a heavy infiltration of lymphocytes, just as we saw in the lungs. And note the cells that were destroyed. Again, this was a very selective process, analogous to what we saw in the lungs. Only the exocrine glands of the pancreas were destroyed. The pancreatic islet cells are virtually untouched. In my opinion, this also supports the theory that we’re dealing with some kind of biological agent. A toxin or poison would have caused a more diffuse injury.”