Brainwaves, page 9
part #8 of Joanna Blalock Series
Lori looked at the films again, then shrugged. “Negative findings usually don’t mean very much.”
“Think in terms of a woman dropping straight down thirty feet and landing directly on top of her head,” Joanna coaxed.
“The fall should have caused multiple fracture dislocations of the cervical spine,” Lori said at once.
“But it didn’t. And that indicates she didn’t land on top of her head.”
Lori checked the X-rays of the skull that were on another view box. She examined them at length. “I see two distinct fractures. The first is a big blowout fracture in the occipital area. The second is a depressed fracture high up on the crown.”
“And what does that suggest?”
“That there were two separate traumatic events.”
“That would be my guess, too. And there’s other evidence to back up the two-hit theory.”
Joanna told Lori about the wet blood on the back on the swivel chair in Karen Crandell’s office. The blood had proven to be Karen’s. “We think somebody bashed her head in while she was at her desk, and that accounts for the blood on the chair and the fracture near the crown of the skull. The killer then threw her down the fire escape to make the murder look like suicide. I believe she landed on the back of her head and blew out the occipital bone.”
“That fits,” Lori agreed, glancing back at the skull X-rays. “Somebody went to a lot of trouble to cover up the murder, didn’t they?”
“And almost succeeded.”
“Any idea who did it?”
“Not even a clue.”
“It’d be nice if an eyewitness suddenly showed up.”
“Don’t hold your breath waiting.”
Joanna stepped back from the autopsy table and looked down at the eviscerated corpse of Karen Crandell. The body had been split open sternum to pubis, all of her organs removed and thoroughly examined. Karen had been in remarkably good health, with pink lungs and wide-open coronary arteries. She could have lived another fifty years. And there were no abnormalities in the pubic area. No scars or foreign bodies or anything else to suggest kinky sex.
But that had been a long shot anyway, Joanna thought, based on flimsy clues. So what if Karen and the Rudds hated each other? There were plenty of reasons to hate somebody other than sex or love gone bad-although that helped. And the fact that the Rudds
tried to come across as macho men didn’t mean much either. Los Angeles was full of people trying to be something they weren’t.
“By the way,” Lori broke into Joanna’s thoughts, “I looked over the slides of Elizabeth Ryan’s brain.”
“And?”
“Nada, nothing,” Lori said sourly. “There wasn’t even a hint of hemorrhage. I did see some pinpoint smudges here and there, which were probably artifacts.”
“You’d better repeat the stains.”
“Right.”
“What about her tumor?” Joanna asked, examining the inner surface of Karen’s thighs for trauma, but finding none.
“Malignant as hell,” Lori reported. “And it had spread far more than the MRI had indicated. She would have been dead in months, even with the surgery.”
“Well, at least Moran tried.”
“That’s about all he’s done lately,” Lori said disapprovingly.
Joanna looked up. “What do you mean by that?”
“I pulled the charts on every brain tumor Moran has operated on during the past two years,” Lori replied. “I wanted to see if there had been any other cases of sudden death on the operating table.”
Joanna’s eyes twinkled. “You’re starting to think like a detective.”
“Is that good or bad?”
“Good. What’d you find?”
“No other sudden deaths,” Lori told her. “But his success rate is not all its cracked up to be.”
“You’d better double-check,” Joanna advised.
“Moran’s success rate with malignant gliomas is among the best in the world.”
“That was early on,” Lori said. “His first two cases were apparent cures. The third lived for more than two years. I guess that’s what established his reputation. Since then his record is just like everybody else’s. Most of his patients die in a matter of months.”
“But no sudden deaths other than Elizabeth Ryan. Right?”
“Not a one.”
Joanna shrugged. “Well, it was a good idea and worth a try.”
“It may have been worth a try, but I think I upset some people doing it.”
“Who?”
“Moran,” Lori said, lowering her voice although no one was within earshot. “Dan Rubin told me that Moran somehow found out that I was reviewing all his old cases and he got mad as hell. Apparently he doesn’t like people snooping around.”
“Too bad,” Joanna said flatly.
“He can cause real trouble, Joanna.”
“So can I.”
A picture of Christopher Moran flashed into Joanna’s mind. She didn’t like him and never had. He was one of the few people she had disliked instantly, from the moment they met. And that was before she learned that he was an arrogant bully accustomed to pushing people around and getting away with it.
Joanna glanced over at Lori and saw the worried expression on her face. “Don’t worry about Moran.”
“It’s not only that,” Lori said hesitantly. She took a
deep breath before continuing. “I was wondering if I should go out with Moran’s intern, Dan Rubin.”
“Has he asked you?”
“No. But he will.”
“Do you want to date him?”
“Yeah.”
“Then go for it.”
“But Moran will find out and think I’m dating Dan so I can snoop around neurosurgery.”
Joanna grinned. “Well, if the opportunity arises …”
Lori poked Joanna’s arm playfully and grinned back. “I’m being serious.”
“I am, too,” Joanna said. “If you want to date Dan Rubin, date him. Don’t let Moran dictate what you do or don’t do.”
“And there’s something else holding me back,” Lori admitted, lowering her voice even further. “The singles crowd at Memorial is really nosy and prying. Everybody knows everybody else’s business, and they love to talk about who is doing what to whom. If you date somebody from the hospital, everybody seems to know about it the next day. And I hate that. My social life is private, and I want to keep it that way.”
“Dan Rubin doesn’t seem like the talkative type to me.”
“Maybe I’ll go for it,” Lori said, still uncertain. “It’s just the gossip and rumor mill that goes on here. You jump in bed with someone, and the details will be common knowledge within twenty-four hours.”
“Are you talking from personal experience?”
“Not yet. And that’s how I’d like it to stay.” Lori slowly shook her head. “God! Some of the things I’ve
heard about the others. You can’t keep a damn thing secret here.”
Joanna’s eyes narrowed. “Did you ever hear anything about Karen Crandell’s social life?”
“Naw,” Lori said at once. “I’m talking about the younger crowd. You know, under forty.”
Joanna asked casually, “What about the Rudd brothers?”
“Ho, ho, ho!” Lori chuckled. “You heard about that, too, huh?”
“Heard about what?” Joanna asked quickly.
Lori’s face grew serious. “It’s really not all that funny. It seems one of the twins took out a young, pretty radiology technician. He was charming and witty. They had a great dinner at some expensive restaurant in Beverly Hills. When they got back to his house, the twin went into his room. A moment later he returned with his brother. Both were wearing only jockey shorts. They tried to convince her how great it would be for her to get laid by both of them at the same time.”
“Christ,” Joanna groaned. “What did she do?”
“Got the hell out of there as fast as she could.”
“Smart girl.” Joanna thought back to Jake’s observation that the macho appearance of the Rudd brothers could mean they were into kinky sex. “You figure they’re into kinky sex?”
“I wouldn’t call that behavior normal. Would you?”
“But no rough stuff or leather or S&M?”
“Not that I heard about,” Lori said, becoming keenly interested. “Why?”
“Just curious,” Joanna said evasively. “Let’s look at the back of Karen’s head.”
They turned Karen Crandell’s corpse over on its
stomach and began examining her head and neck. The entire back of the skull was a mass of tangled hair and brain and splintered bone.
“Look at that massive blowout fracture,” Joanna commented. “Most of the occipital bone is either gone or ground into her brain.”
“That had to be the point of maximum impact,” Lori added.
“It’s amazing how much damage a fall of thirty feet can cause.”
Lori pointed to a white, powdery substance that was scattered throughout the fracture site, “What do you think that white stuff is?”
Joanna reached for her magnifying glass and closely examined the fracture and the area around it. “The white material consists of small granules and flakes. I suspect it’s either plaster or paint from the concrete landing on the staircase. We’ll check it out.”
“And that would be solid evidence that she landed on the back of her head and not the top.”
“But that doesn’t bring us any closer to the person who did it.”
Joanna moved to the crown of the corpse’s head. Here the fracture was also obvious, but not as large. The scalp had been split open, the bone beneath fractured and depressed. Joanna could see blood and some loose spicules of bone, but the brain was still covered by the skull.
A slender brown sliver caught Joanna’s attention. It was a centimeter long with jagged ends. Using a small forceps, Joanna extracted the sliver from the bone where it had been embedded. Then she found another
sliver. This one was a bit longer and again deep brown in color.
“What is that?” Lori asked.
“I have no idea,” Joanna said. “But it shouldn’t be here.”
7
Marci Gwynn lay on the operating table with her eyes closed, not wanting to see the doctors and nurses or the instruments they would use to saw her skull open.
Why is this happening to me? her brain screamed for the hundredth time. Why is God doing this to me?
Again she prayed that this was all some terrible nightmare she would soon awaken from.
“Marci, how are you doing?” a nurse asked.
“All right,” Marci lied, wanting to run for her life and hide someplace where they’d never find her.
But that wasn’t possible now. They had her arms and body strapped to the table. Even her head was immobilized, held in a fixed position by some kind of vise.
“You’re going to do fine,” the nurse said soothingly.
No, I’m not, Marci wanted to say. They’re going to operate on my brain, and I could end up paralyzed or blind or dead or with a hundred other things that were listed on the consent form I signed.
“I have to catheterize you now, Marci,” the nurse said.
“What?”
“I’m going to place a small tube in your bladder,” the nurse explained. “It’ll just take a minute.”
Marci felt her legs being lifted up and spread apart, exposing her pubic area. She squeezed her eyes tightly together and tried to hold back the tears, but they flowed out anyway. She heard herself sobbing and tried to stop that, too.
“I’ll give you something to help you relax, Marci,” the anesthesiologist said from behind her.
Marci opened her eyes and strained to look back. All she could see was a pair of hands and a small glass vial he was holding. Then she felt something wet and cold around her bottom. It took her a moment to realize that the nurse was scrubbing her genitals. She now lay exposed for all the world to see.
The pace in the OR quickened. Nurses began moving back and forth with trays of instruments. Doctors in gowns and masks were snapping on latex gloves and talking in mumbled conversations that Marci couldn’t understand. In her peripheral vision she saw a mounted overhead Zeiss operating microscope. Marci shivered to herself, remembering what the microscope would be used for. Dr. Moran had explained how he would use a microscope to dissect out her brain tumor.
She felt a sudden pain between her legs, then a dull pressure in her bladder. Marci tried to lift her head up against the restraints, but it barely budged. She sensed something being taped to her thigh. Then her legs were gently guided back down onto the operating table. On a nearby table Marci noticed a gleaming silver instrument of some kind.
It was large and resembled a power tool. She wondered what it was used for.
Her attention turned to a tall surgeon approaching the operating table. He had his gloved hands clasped together across the front of his chest.
“I’m Dr. Belios, the chief resident in neurosurgery,” he said, glancing over at the X-rays mounted on a side wall. “Do you remember our conversation yesterday?”
Marci nodded, although she really couldn’t place him. She had seen so many doctors at Memorial the past few days. An endless line of faces that came and went and never came back.
The chief resident pointed to another doctor by his side. “This is Dr. Rubin, who will assist me. All we’re going to do is scrub the area where the incision will be made. It’s important we get the operative field nice and sterile.”
Marci stiffened with fear. “Where is Dr. Moran?”
“He’s scrubbing up,” Belios told her. “He’ll be in shortly.”
Marci felt cold liquid being vigorously rubbed into her bare scalp. It reminded her that she was totally bald. The night before they had cut off her flowing brown hair, then shaved her scalp down to the skin. Marci had cried while they were doing it, feeling as if they were removing an important part of her femininity. But she was smart enough to have brought along a wig that closely matched her real hair. When her parents and her fiance, Chip Kennedy, had come to kiss her good night they saw the beautiful Marci, not the shaved, ugly one. Chip had left a shamrock on her pillow to bring her good luck.
Luck, Marci thought miserably, wondering if hers had run out. She had always been lucky. Always. She was born into a wealthy New England family. Her life had been one of never-ending privilege. Private schools, private country clubs, private planes. She was pretty and bright and always had more boyfriends than she knew what to do with.
After graduating from Brown, she went to New York, where she became an editorial assistant at Cosmopolitan. Soon a close friend suggested that Marci would make a great model. Marci initially rejected the idea, thinking that it was a brainless profession that would soon bore her. But, on a whim, she decided to see what modeling would be like and signed with a prominent agency. Within a year she was a top model, living in Los Angeles and commanding a fee of $500 an hour.
Then the headaches started. Initially Marci thought they were caused by the excitement and nervousness associated with her upcoming wedding to Chip Kennedy, an investment banker. But the headaches grew more intense and lasted longer. When her left leg became weak, Marci knew something was terribly wrong. She saw two doctors before she was diagnosed with a brain tumor and referred to Dr. Christopher Moran. Marci’s luck had run out.
“Marci, we’re going to draw a line on your scalp with a felt pen. Okay?” Belios asked.
“Okay,” Marci whispered, fear again flooding through her body. She knew what was coming next. The knife! The line was being drawn to show the surgeon where to cut.
Marci felt the pen marking her head. It seemed to
be moving from just above her ear to the top of her head. Why were they making the incision so long? Was her brain tumor that big?
“Ooww!” Marci cried out as a sharp pain shot through her scalp. Then came another stab of pain. It felt as if her scalp was going to explode. “Please don’t! Please!” she pleaded.
“We’re almost done,” Belios said. “That was just the local anesthetic being injected.”
Marci’s heart pounded in her chest. Her fear increased by quantum leaps as she remembered what they were going to do next. They were giving her a local anesthesia because they wanted her awake during the first part of the surgery. They had to make some type of map of her brain because the tumor was close to the memory area. They had to determine what they could cut out and what they couldn’t. And they had to open her skull to chart the map.
Classical music suddenly came on in the OR. It sounded like Beethoven’s Ninth Symphony to Marci. If it was meant to calm her, it wasn’t working. Instead, the music gave her a feeling of doom.
The door to the OR swung open and Christopher Moran entered. A nurse rushed over with latex gloves and held each up and opened wide so Moran could slip his hands in.
Moran glanced over his shoulder at the lines drawn on Marci Gwynn’s head. “Your inferior incision is too low,” Moran said to Belios in a gruff voice. “We’re not doing a brain transplant here. We’re taking out a three-centimeter tumor.”
“Yes, sir,” Belios said. “But I put in plenty of local
anesthesia, so there’s no problem if you wish your incision to be higher.”
“Redraw the damn line,” Moran commanded.
Belios hurried over to do it, making sure the area of the newly drawn line was fully anesthetized.
Moran checked the X-rays on the wall, then the instrument tray next to the operating table. Satisfied that everything was in order, he turned to Marci. “How are you doing, young lady?”
“I’m so scared,” Marci said, her voice trembling.
“You have every right to be,” Moran said. “But you’re going to get through this fine. In a few minutes we’ll have you sound asleep.”
Marci nodded, still badly frightened but feeling a little more secure with Christopher Moran. She had liked the way he took control of her case with his straightforward, no-nonsense manner. The other specialists she had seen were all sympathetic but didn’t offer her much hope. Her chances were very slim, they all said. Only Moran had told her she had a real chance to survive. Only Moran had mentioned the occasional case of glioma that not only survived but appeared cured. He offered her hope, and she was going to cling to it with all of her might.
