Archer Mayor - The Skeleton's knee

I have a body for you.

The voice on the line-smooth, cultured, and completely serious-was Beverly Hillstroms, Vermonts chief medical examiner.

I cradled the phone between my shoulder and cheek and poured several packets of sugar into my coffee. Unlike the larger urban charnel houses of New York or Los Angeles, the Brattleboro, Vermont, Police Department did not export corpses to the MEs office for autopsy every day of the week, nor even once every six months. When we did, it was usually an unwitnessed death-an elderly person whod died alone in bed, and for whose demise the law required an explanation.

Homicides, the only other professional reason for the ME and I to talk, were rarer still, although recently we had given those numbers a boost during a particularly bloodthirsty case. But that was now history; to my knowledge, we hadnt shipped a body from either category since.

I was, therefore, totally baffled. It came from here?

She was suddenly, and uncharacteristically, less sure of herself. Its an adverse-occurrence case, sent to me by Dr. Michael Brook. You know nothing about this?

I dont even know what an adverse occurrence is.

Its when a patient dies of something other than what hes being treated for. For example, a cardiac patient dying of undiagnosed cancer.

Uh-huh, I muttered, waiting for the inevitable punch line.

Or an orthopedic patient dying of an aneurysm caused by a bullet.

I let out a little puff of air. Who are we talking about?

Someone named Abraham Fuller, age forty-seven. He was sent to me by Brattleboro Memorial Hospital, where hed checked in with severe back pain and lower-limb paralysis, which X-rays revealed to be acute osteomyelitis. He suddenly up and died in the hospital two days later, and Dr. Brook wanted me to take a look.

And you found a bullet wound.

Specifically, I found a traumatic aortic aneurysm caused by a bullet crease some time ago.

I put my feet up on my scarred wooden desk and rocked my chair back, getting comfortable. Some time ago? How long?

Ill give you the long-winded answer to explain why I have to be a little vague on the timing. When a bone is damaged, as part of Mr. Fullers spine was by the same bullet, it undergoes a series of sequential changes before stabilizing, much as the skin does when it scars over. But the process with the skin occurs rapidly, whereas the bone takes its time, five years generally, from start to finish. Technically, all I could say is that since Mr. Fullers bone-tissue exhibits having gone through this entire process, his wound is at least five years old.

I caught her inference. And not so technically?

Between you and me, based on my own experience, Id say it was easily twice that, and maybe more. But I couldnt back that opinion up with one shred of scientific data.

I sighed and closed my eyes. A time-honored policemans adage has it that with homicides, if you havent nailed your killer inside a week, your chances of ever doing so divide by half for every subsequent week that passes. So in a nutshell, youve just given me one very old, cold homicide.

Im afraid so.

The aneurysm could only have been caused by the bullet?

I found trace elements of metal and had them sent to Waterbury for analysis under the scanning electron microscope. They were consistent with the lead used in bullets. Also, I have both an entrance and an exit wound, and internal scarring defining the trajectory within the body. So yes, the aneurysm was caused by a bullet and death was due to the aneurysm.

What took the aneurysm so long to burst?

Thats hard to say. I could venture a few guesses, but none of them would do you any good. Lets just say hed reached his time.

I turned all this over in my mind. He must have been wounded before he moved to the area. I dont remember any local ending up in a wheelchair from a gunshot wound.

He wasnt confined to a wheelchair. The paralysis I mentioned was recent, stemming from a sudden infection that formed around the old bone and lead fragments.

A sudden infection? Did he reopen the wound?

There was a pause at the other end. He might have done something to precipitate it; not reopen it, precisely, but perhaps to cause a shifting of sorts. You see, those fragments were not frozen in place. To a certain extent, the ones that werent encapsulated by the healing bone were free to wander a bit. It was one of the fragments that triggered the osteomyelitis, which in turn led to an abscess-a dumbbell lesion, specifically-that expanded into the spinal canal, put pressure on the lower cord, and thereby cut off the use of his legs. This is not so rare, by the way; its part of the reason why surgeons are so careful to remove everything they can from a wound. There are dozens of stories of people stepping on shards of glass and having them pop out of the skin years later far from where they entered.

I paused a few seconds, reviewing the little I had. Over the phone, I could hear the faint strains of the classical music she favored in her office. Could you tell if Fuller was treated at the time he was shot? Were there any suture scars, for instance?

None, and I looked carefully. Either the attending physician decided to leave well enough alone or Mr. Fuller never sought treatment. If the latter was the case, Id say he used to be a very lucky man.

Would he have required professional home care, at least?

Not necessarily. I followed the scar tissue the bullet left behind. It entered between the navel and the left rib cage, missed the liver, spleen, and left kidney, nicked the aorta and the left transverse process of the spine, and exited. It must have been extremely painful at the time, but neither fatal nor permanently debilitating. Aside from the aorta, nothing vital was hit. He had to have been terribly uncomfortable, and its amazing the wound didnt become infected, but he could have recovered simply by staying put. The irony was that his recovery turned out to be a false one. One millimeter the other way and he would have been dead. As it was, the wound became a time bomb.

But wouldnt he have had a limp, or chronic back pain?

Youll have to confirm this with Dr. Brook, but I doubt Mr. Fuller had much trouble with his spine until recently. His muscular development in the area of the wound indicates a full and normal range of motion. There were also no signs of long-term chronic infection. If I had to guess, Id say hed led a perfectly normal life until the abscess developed. In fact, Ive rarely examined a healthier specimen. He didnt smoke, wasnt overweight, his stomach and intestinal contents revealed a vegetarian diet, and his liver was so good-looking, I doubt he drank much alcohol.

I smiled at her enthusiasm. Despite the derision it attracted from my colleagues, I, too, enjoyed autopsies for the insights they provided. They reminded me of searches Id conducted through peoples homes, apartments, and luggage, which also were usually rich in personal details.

You couldnt guess what the caliber was, could you?

Not with any precision, but it wasnt large. Say anything from a.32 on down.

I let out a small grunt. Well, it looks like I better start digging. Could you send me copies of what youve got, especially a shot of his face?

I have a courier heading to Rockingham in a couple of hours. Ill ask him to extend his trip a little.

Thanks. By the way, who has claim on the body?

No one. The record shows no next of kin and no claimant.

That surprised me. What about an address? Could he have been a street person?

He had none of the outward signs. His teeth, nails, hair, and general hygiene didnt reflect that kind of life, unless he was new to the street. The hospital probably has all that.