Endowed with Death, page 2
She dressed, scrubbed, and tapped the button on the floor to make her initial recording. She introduced the case with the patient name, date, and details of the death they had been given. It was clear that George had already examined the body for any forensic evidence and washed it in preparation for Kenzie’s arrival. Kenzie hadn’t seen him in the outer suite when she had come in. He had probably been called in especially for this case, as she had, and had gone home when he was finished preparing the body for her.
Kenzie proceeded with a gross examination of the body, carefully noting any defects, bruises, cuts, or anything else that might be important later. No birthmarks. A variety of bruises, as was the case for most toddlers. Kenzie studied them closely, and moved the body from front to back and then front again.
“Something of note?” Dr. Wiltshire asked.
“No. I don’t know. There are bruises on his arms, upper and lower, and on both his back and front.”
“Recent? From today?”
He could see the coloring as well as Kenzie could, and had drilled her in the past about the colors the bruises went through from the time they were inflicted until a week or two later. Everyone healed at different rates, of course, but the order of the colors was always the same, and the timeline could be estimated.
“No, nothing that is obviously today. But they wouldn’t be, would they? How long before the accident did he get out of bed?”
“Not long. It wasn’t clear from the report from the police at the scene whether he had been up interacting with a caregiver before the incident, or went straight from bed to the balcony before they knew he was up.”
There would be a number of people to interview, Kenzie suspected, and anyone who was closely connected to the boy might be too distressed to give a clear statement in the first few hours of the investigation.
“The bruises are a variety of ages,” Kenzie observed. “I know that kids get into trouble, some of them more than others. And some kids bruise quite easily. But… it seems like a lot.”
“Make sure they are all documented. You may want to try an alternative light source as well. You may be able to see other bruising under ALS.”
Kenzie nodded. It was tedious to measure, take pictures of, and describe each bruise. And the ones on the shins, knees, and elbows seemed to be the typical accidental injuries of a child just learning to get around in the world. But the documentation needed to be done before moving on to other things.
“What position was the body in when the police got there?” Kenzie asked, as she examined the signs of livor mortis, the settling of blood in the body after death.
“The child was on his back but had obviously been moved. The damage to the skull is in the front. That has to be the position he landed in.”
“Did the parents say they had moved the body?”
“They probably don’t know. It’s instinctive to turn the person over, look them in the face.”
Kenzie nodded. She recorded her thoughts and questions and proceeded. When she had finished with the gross examination, she moved on to the eyes, ears, and mouth. Unsurprisingly, all three showed traumatic changes. That would happen when plunging face-first into the pavement, even falling from just a few feet up. Kenzie took pictures and set aside one eyeball for microscopic examination.
She looked at the mouth, frowning. Dr. Wiltshire looked up at the screen as she took a few pictures and moved the camera in for a closer, enlarged view.
“Observations?” Dr. Wiltshire asked.
“No broken teeth. The blow was closer to the top of the head than the front of the face. But there is significant bruising and tearing of the frenula.”
“There is,” Dr. Wiltshire agreed.
Kenzie met his eyes, then returned to the autopsy. She examined the mouth injuries closely and considered the color of the bruising. Not bright red. Not sustained in the fall.
3
Kenzie would need to do a microscopic examination of the eyes to gather all the information she could. There was blood visible on gross examination, but she would need more magnification to make a full evaluation.
“X-rays?” Kenzie asked.
Dr. Wiltshire nodded. She didn’t really need to ask; she knew what needed to be done. “What will you x-ray?” he prompted.
“Head, of course, we will need to see how extensive the skull fracture is. Neck and shoulders.” She paused. “Ribs, front and back. From there… we’ll see.”
He nodded his agreement.
Kenzie proceeded as planned. Dr. Wiltshire took a break while she did the films, so he didn’t have to worry about a lead shield. Kenzie could see him through the window to the observation room, swigging some pills down with a bottle of water. She eyed his splinted hand while waiting for the machine to perform each of the x-rays she needed. It appeared to be a temporary splint, not a full cast. Hopefully, that meant it was only a minor injury, a hairline fracture or two that would heal quickly and without further intervention. She hadn’t been able to see how much swelling and bruising there was because of the way that it was wrapped, so she couldn’t guess at the extent of his injuries.
When Dr. Wiltshire came back in, she queued up the x-rays and they reviewed each one. The most important ones in determining cause of death were, of course, the skull x-rays. The massive fracturing from the fall was certainly extensive enough to have caused the child’s swift demise. But it didn’t sit right with Kenzie. It didn’t match up with some of the other observations that she had made.
The neck and shoulders were also consistent with a fall from a height, with the heaviest part of the child, the head, hitting the ground first.
Kenzie put up the rib x-rays without a word, and she and Dr. Wiltshire studied them.
“What do you see?” Dr. Wiltshire invited.
Kenzie sighed and shook her head. She used the mouse pointer to indicate the callus formations on the posterior of several ribs, bright white on the x-ray. “String of beads,” she said. “That’s how my professor described it in med school.”
“Which indicates?”
“The child has been squeezed or shaken hard enough to fracture ribs. In the absence of any brittle bone or connective tissue disorder… abuse.”
“Resulting in death?”
“No. The calluses are healing fractures. Meaning it happened at least a few weeks before death.”
Dr. Wiltshire nodded. “Follow-up questions for the investigators?”
Kenzie considered, then recorded several questions for the police to follow up on. Whether the custody of the child had changed recently. Whether there were any previous investigations into abuse. How many doctor and emergency room visits he’d had, and for what. Whether he had any diagnosed disorders.
“And we’ll need to take bone samples to review for disease,” Kenzie said, anticipating his next question. “See whether there is another explanation for multiple rib fractures.”
At least there wasn’t any danger of a child being inappropriately apprehended by DCF for abuse when there was actually an underlying disorder, traumatizing the child and putting unnecessary stress on the family.
But they would need to be mindful of the political consequences of any questions or reports that included allegations of abuse. Cash Wade was not a man to be trifled with. A number of ruined careers lay in his wake.
Eventually, they reached the point at which dissection was necessary. Kenzie wished that it could have been avoided. If there had been no findings in the gross examination and x-rays, and everything was consistent with a fall, Kenzie could have chosen to dispense with a full autopsy, ruling it an accidental death and avoiding any further indignity to the body.
But that was not the case.
Kenzie was bothered by the head x-rays and her observations of the tissue around the fractured skull, so she started there instead of with the Y-incision. Dr. Wiltshire made no comment or correction.
Kenzie made her cuts and peeled back the skin and tissue covering the skull to examine it, then removed pieces of the shattered skull to examine the bone and the bleeding within the subdural layer.
Except there was no bleeding.
She took a series of pictures of the membranes around the brain. The shards of the skull created by the explosive impact had cut into the membranes, blood vessels, and brain tissue. Yet there was little blood.
Kenzie pressed her lips together tightly.
“There was no bleeding from the fall. The victim was dead before he fell from that balcony.”
Dr. Wiltshire shook his head, but it was in regret, not disagreement. “I concur.”
The revelation that Michael Wade had not been killed in the fall from the window was only the first part of the answer. There was still more work to be done. And much of the evidence might have been compromised by the fall.
Any bone breaks could be the result of the fall or might have been inflicted earlier. The damage to the frenulum, Kenzie had already noted, could not have been perimortem. Neither were the previously broken ribs. Though looking at the x-rays under magnification, Kenzie could identify recent hairline fractures. Not starting to heal yet. Possibly caused by the fall or possibly broken within the previous few days.
Before proceeding with the dissection of the torso, Kenzie took a closer look at the bruising inside Michael’s mouth and also dissected one eyeball under magnification. She was straightening up and arching her sore back when she saw that a couple of police detectives were in the observation room. A male cop she recognized as Detective Tuttle, and a woman she didn’t know. Dr. Wiltshire had undoubtedly called them when Kenzie had discovered the boy was already dead before he fell. Kenzie instructed the computer to turn on the speaker in the observation room.
“Did Dr. Wiltshire fill you in on everything?”
Tuttle stepped forward, closer to the mic in the observation room. He pressed the click-to-talk button and addressed her.
“He told us there was no bleeding from the skull fracture, so Michael was dead before he fell.”
Kenzie nodded. She waited for anything more, but that was all the detective had to offer. Dr. Wiltshire had only given them the minimum they needed to know to get them there and give them a heads-up that it was now a homicide investigation. Michael hadn’t climbed over the railing. Whoever had dropped him off the balcony had intended to cover up the actual cause of death, and that suggested homicide, not accident or natural causes.
“We have made a few other findings that you need to know about for your investigation.”
“Go ahead.”
Kenzie showed them the pictures of the torn and bruised frenulum. “This is Michael’s frenulum. It is that little string of tissues that holds your lip to your upper gums. As you can see from the dark bruising, this happened several days ago, not today.”
“What causes that kind of injury?”
“This is sometimes referred to as a bottle jamming injury. It can be caused by a bottle, pacifier, spoon, or other object being forced into the child’s mouth. Usually by a frustrated caregiver trying to force feed or quiet them. It can also be caused by a hit or slap directly to the mouth.”
“Not an accidental injury, then.”
“It would be very rare for it to be an accidental injury. It is almost always indicative of abuse.”
“But you don’t know by whom.”
“Obviously, I can’t tell that from the bruise.”
Kenzie showed them the x-rays, indicating the damage that was definitely caused by the fall, the healed or healing fractures that were not caused by the fall, and recent breaks that could not be determined to be one or the other.
“Have there been any previous investigations into abuse?” she asked.
“Not that we are aware of. We will look into it.”
“Is that everything you have so far?” the female detective asked.
“Not yet. I’ve just been investigating the ocular injuries,” Kenzie gestured to the organ she had been dissecting.
“Eye injuries?” the woman inquired.
“Right.” Kenzie pulled up the photos she had taken so far and indicated areas of damage. “There are a number of retinal hemorrhages. Areas where the tiny blood vessels of the retina have bled. Experience tells us that this is usually caused by traumatic head injury.”
Dr. Wiltshire had returned to autopsy, but did not interrupt, letting Kenzie deal with the presentation and answering any questions.
“Like the one sustained by the victim?”
“Not from the fall from the balcony. If the head injury did not bleed after the fall, then neither did the eyes. These injuries were sustained before death. They appear to be recent. It’s possible that the drop from the balcony was meant to obscure another head injury. And if that was the intent… then so far, they have succeeded. I’ll be doing a more thorough examination of the skull and brain to see what preexisting injuries I can identify. As well as the hemorrhages, you can also see some retinal tearing.”
“That’s quite serious,” Tuttle suggested.
“Yes, retinal tearing can lead to blindness. The tears in this case are quite small. Still, retinal tearing in children is almost always associated with trauma, unlike in adults where it can be spontaneous, part of the natural aging of the eye.”
“Caused by being hit in the head?”
“Hit in the head or shaken violently. It could be the result of injury sustained in sports or roughhousing, but in most cases…”
“It is indicative of child abuse,” the female detective finished.
Kenzie nodded. She looked the woman over. “I don’t think we have met before, Detective…?”
“Oh, sorry. Detective Baker.”
“Baker. Yes, retinal hemorrhages and tearing are common signs of Shaken Baby Syndrome. But they can occur in older children, too, not just infants. It is easier to cause damage shaking an infant, because their heads are so heavy and they have little control or stabilization until they get a bit older.”
“So did these happen when he was a baby or more recently?”
“The hemorrhages are recent. The tears do not show any sign of healing or scarring, so I assume they were both caused recently.”
“And is that all you’ve got?” Baker inquired.
“Do you need more than that to begin your investigation?”
“No, no. I just don’t want to race out of here if you still have more to tell us.” Baker gave her a little smile to show that no offense had been intended.
“Okay. Yeah, that’s all I’ve got for you so far. But as you can see, I’m not done with this autopsy. I imagine Michael still has a few more things to tell us. But it will probably be along the same lines… signs of recent child abuse as well as older, healed injuries. You can see from the bruising…” Kenzie brought up a few representative pictures, “that these injuries are different ages. This is not just one incident of a parent losing their temper.”
Baker and Tuttle both nodded.
“We’ll look into it further,” Tuttle confirmed. He looked hesitant. “You have heard, I assume, that this is the child of…”
“Cash Wade,” Kenzie filled in. “Yes, so I heard. But he is not immune from investigation. If he or his wife had something to do with this…”
“We’ll find out. I just mean… you will need to be careful of what you say. Keep this very quiet, don’t let anything leak out. If there are accusations or innuendo made in the media before the facts are established…”
“It won’t leak from here.”
“Good.” Tuttle nodded. “I don’t mean to make any accusations. Just to make sure you’re aware of how sensitive the situation is and how easily it could get out.”
“I’m sure that Mr. Wade’s PR people will be feeding the story to the press with their own spin,” Dr. Wiltshire said. “But that won’t stop people from speculating. There will be accusations of abuse made without anything coming from this office. And unfortunately, we will not be in a position to refute anything that is said. All we will be able to say for the time being is that it is under investigation.”
Tuttle looked like he would argue, but he just nodded again, keeping his lips pressed tightly together.
“Keep us informed as to what is happening in the investigation,” Wiltshire requested. “Any circumstances we need to be aware of to interpret our findings. And if you have any questions regarding scenarios or the specific injuries we have found…”
“We’ll keep in touch,” Baker agreed.
She and Tuttle left the observation room, expressions grim.
4
It was past their usual dinnertime when Kenzie arrived home. She was tired from the physical work and emotional toll of the autopsy, glad to be home where she could rest and regenerate.
She had called Zachary to let him know she was on her way home, so she was a little disappointed to see that he hadn’t started dinner preparations by the time she arrived. It must have shown on her face.
“I have a plan,” Zachary assured her quickly. “But I didn’t want to start too early. I figured you would want a shower and change before you eat. You usually do.”
It was true. After a particularly grueling autopsy, she always felt sweaty and disgusting and wanted a nice hot shower to scald it all away.
“If you need something right away, I can bring you a drink,” he offered.
Since she shouldn’t drink alcohol on an empty stomach, that would be a fruit juice or soft drink. She could have a glass of wine later with dinner.
“Yeah, that all sounds good. Why don’t you bring me a grapefruit juice?”
Zachary’s relief at her reaction was obvious. “Will do!” he agreed.
Kenzie retired to the bedroom to drop off her purse and other items. She started the shower warming and began to undress. Zachary brought her a glass of grapefruit juice.
