Chapter 22 Chapter Nineteen

Brighton, Massachusetts Thursday, June 8, 2006 Six in the evening: forty-five The next few things also went well, and Jack was very satisfied.He from Parker.Meadow Cemetery to Langley Pearson Funeral Home, all the way unimpeded.Harold escorted the coffin, and there was no problem.When Jack arrived at the funeral home, Latasha was already waiting for him there, and she had only arrived for five minutes.The timing of the two sides is quite well connected. As soon as Harald got out of the car, he asked two strong employees to unload the eternal rest coffin from the hearse, put it on a trolley, and push it into the embalming room for storage.

That's how I arranged it, Harold said.He stood by the coffin, his bony hands resting on the metal surface of the coffin.The embalming room was turned on with blue and white fluorescent lights, which made everything lose its original color.Harold looked as if he should be in a coffin for eternal rest. Jack and Latasha stood a few feet away from him at the embalming table, which today served as an impromptu autopsy table.Both of them were wearing high-density polyethylene synthetic paper protective suits that Latasha brought specially from the Forensic Medicine Department.She also brought gloves, a plastic mask and a full autopsy kit.There was also an elderly and kind gentleman in the room, Bill.Barton.Harold introduced this as his most trusted employee.There was also a solid black man, Tyrone.Vichy was as tall as two Bills.Barton.Both offered to work overtime.That way Jack and Latasha could help if they needed anything.

Open the coffin first, Harold went on.I need to make sure it's actually Patience.Stanhope's body.Bill and Tyrone will take the clothes off the body and take it to the embalming table for you to do the autopsy.After the autopsy, Bill and Tyrone took over.They will redress the body and put it back in the coffin so it can be reburied tomorrow morning. Will you stay at the funeral home?Jack asked. I don't think it's necessary, Harold said.But I live nearby.Bill and Tyrone would call me if something went wrong. I think it's a good arrangement, Jack said, rubbing his hands together excitedly.Let's get started!

Harald took the crank from Bill, inserted one end into the notch on the side of the metal coffin, fixed it, and began to spin the crank.As soon as he tried hard, his face turned red from holding back, but the air lock of the coffin did not open.Harold beckoned to Tyrone to take over.As Tyrone began to push, his muscle mass gradually swelled, and he could feel it in his cotton overalls.With a scalp-numbing scream, the coffin was finally opened.After a while, another hissing sound was heard. Jack looked at Harold.Is this sound good or bad?Jack asked.He feared it was gas from decaying corpses.

Not good or bad, Harold said.This proves that the air seal of eternal sleep is of good quality.Not surprisingly, this is a top-notch high-tech product.Harald sent Tyrone to the other side of the coffin and cranked the notch on the other side. All right, said Harold when Tyrone was done.He put his fingers inside the edge of the coffin, and told Tyrone to cooperate at the other end, and they both lifted the lid at the same time, letting the light shine on Patience.on Stanhope. The coffin was lined with white satin, and Patience wore a simple white taffeta dress, with white cotton-like mildew growing over his face, arms, and hands, beneath a marble-grey skin.

There is no doubt that this is definitely Patience.Stanhope, said Harold reverently. Well done, Jack said.Dressed up, ready for the dance. Harold glanced in Jack's direction, seemingly dissatisfied, but ultimately said nothing. All right!Bill Tyrone, said Jack excitedly, took off her evening dress and got to work. I'm leaving, Harald said with a hint of reproach in his tone, as if he was teaching a naughty child.I hope you feel that all the hard work was not in vain. What is your fee?Jack asked.He suddenly realized that Harold's money might be prepared. I have your card, doctor.The bill will be mailed to you then.

Very well, said Jack.Thank you for your help. It's an honor, Harold said wryly.As an undertaker, he resented Jack's disrespectful remarks about the dead. Jack pulled across a stainless steel table on wheels and put paper and pens on it.Without a recording device, he was prepared to take down the autopsy results at any time.Then he helped Latasha prepare the specimen bottles and autopsy tools.While Harold had prepared some tools for embalming, Latasha brought standard forensic tools, including pathology knives, scalpels, dissecting scissors, bone scissors, and bone saws. How thoughtful you are, and bringing so many tools, the autopsy will be easier now, Jack said, putting the scalpel blade on the handle.I was going to use the tools here to make do with it, but now it seems that it really won't work.

It didn't take much trouble, Latasha looked around the whole room as she spoke.I don't know what tools are here.I've never been in an embalming room.To be honest, things are quite complete. This room was about the same size as her autopsy room in the Forensic Medicine Department, but there was only an embalming table in the middle of the room, so it seemed very empty.Pale green tiles cover the floor and walls.There are no windows, but light filters in through the glass tiles on the walls. Jack also looked around.That's good enough, he said.When I first started thinking about this autopsy, I thought it would be done on the kitchen counter.

disgusting!Latasha said.She glanced at Bill and Tyrone.They were busy undressing the corpse.When you went to the medical examiner's office on Tuesday, you told me about Patience.The case of Stanhope and the physician friend.But I forgot the details.Can you give me an overview of the situation again? Jack told her everything about his relationship with Craig, the intimidation he and Craig's children had received because of the autopsy, and even what happened on the Massachusetts highway that morning up. Latasha was taken aback, as could be seen from the expression on her face. I should have told you this sooner, Jack said.Maybe you won't agree to help me so soon.But I think if there's going to be an accident at the autopsy, it's at Patience.Before Stanhope's body was exhumed.

I agree, Latasha's voice is much calmer.If something happens next, it will be related to the results of the autopsy. You're right, said Jack.Maybe you'd be better off not helping.If someone has to pay the price for this, I hope it will be borne by me alone. What?Latasha made a surprised expression.Leaving you alone to enjoy the autopsy fun?thank you.This is not my style.It's better to see what you can find first, and then decide what to do next. Jack smiled.He admired this woman very much and liked her very much.She is not only smart and brave, but also very dedicated. Bill and Tyrone lifted the body out of the coffin and put it on the embalming table.Bill fetched a bucket of water and gently scrubbed the mold off with a sponge.Like the autopsy table, there are grooves around the embalming table, and there is a drain at the end, through which the liquid produced during the dissection can flow away at any time.

Jack stood to Patience's right and Latasha to the left.Both wore face masks and hair caps.Tyrone was out for a routine nightly security check.Bill stepped aside and called him if there was anything to do. The body was so well preserved, Latasha lamented. Harold is a little stuffy, but really professional. Jack and Latasha made external inspections separately, and neither of them spoke.After reading it, Latasha straightened her waist. I didn't see anything out of the ordinary, she said.I mean, she's been resuscitated, she's been embalmed, you can see that. I agree, said Jack.Just now he also saw several fine jagged wounds in Patience's mouth, which were the marks of intubation during artificial respiration before death.So far, there are no signs of strangulation or strangulation, but smothering will not cause chest compression, which is still to be noted. That's highly unlikely, Latasha said.It's clear from her medical history.Do you get me? Understood, Jack said and handed Latasha a scalpel.The heavy responsibility of disembowelling is left to you. Latasha made a standard Y incision, from the shoulder to the midline, and then down to the pubic bone.The tissue was as dry as an overcooked turkey, and had a sallow color.The corpse hadn't decomposed yet, so although it smelled a little musty, it wasn't pungent. Working with Latasha, Jack quickly exposed the corpse's guts.The dirt in the intestines has been cleaned with an antiseptic sleeve.Jack lifts the hard liver with the gallbladder attached to it.He pressed his fingers against the gallbladder. Bile, he said cheerfully.Toxicology tests are available. The vitreous was also there, and Latasha pressed the closed eyelids.Sample testing may be required. Of course, Jack said.There are also urine samples, which can only be found in the bladder or kidney. The two took samples separately with needle tubes.Jack put a label on his own bottle, and Latasha did the same. To see if there is a significant right-to-left atrial shunt, Jack said.I have always felt that the key to this autopsy is to find out the cause of cyanosis. Jack carefully removed the brittle lungs so he could see the great blood vessels.After touching the blood vessels carefully, he shook his head.Everything looks fine. The cause of death can only be in the heart, Latasha said with certainty. You're right, said Jack.He asked Bill to look for stainless steel plates or bowls that could hold the organs.Bill retrieved some dishes from the cabinet under the sink in the embalming room. Jack and Latasha took out the heart and lungs together.The two cooperated very well, as if they had worked together for a long time.Latasha carried the tray, Jack lifted the heart and lungs from the chest cavity and placed them on the tray, and she carried the tray to the dissecting table at Patience's feet. The lungs look normal, Jack said, running his fingers over the surface of the lungs. It also feels normal, Latasha poked it lightly a few times as she spoke.Too bad there are no scales here. Jack called Bill over and asked if there was a scale.Bill said no. I think the weight is normal, Jack said, weighing the mass of tissue with his hands. Latasha tried it too, then shook her head.I'm not very good at judging portions. I'd love to dissect the heart now, but the other parts shouldn't come first.What do you think? Work first, enjoy later.Is this your motto? All right, said Jack.Let's divide the work, so we can go faster.One examines the abdominal organs while the other dissects the neck.Just to be on the safe side, I wanted to make sure the hyoid bone was intact, although strangulation is unlikely to both of us. If I had to choose, I'd rather dissect the neck. you please. For the next half hour, the two quietly checked their respective areas.Jack rinsed his bowels at the sink.The first significant pathological finding was in the large intestine.He called Latasha over and showed her.There is cancer in the ascending colon. The cancerous area was small but appeared to have penetrated the bowel wall, Latasha said. I think it's penetrated, Jack said.And part of the abdominal lymph nodes also appeared enlarged.Dramatically proving that hypochondriacs are sometimes real illnesses. Can't this be detected with a colonoscopy? If she is willing to do a colonoscopy, of course she can find out.Craig suggested she do it, but she kept saying no, and it's all in those medical records. In other words, if it is not a heart attack, she may die of bowel cancer. Eventually died of bowel cancer, Jack said.Where is the neck dissection? Almost done.The hyoid bone is intact. good!I finished the abdomen, you take this time to take out the brain tissue.We are still very fast.Jack looked at the clock on the wall.It was almost eight o'clock, and his stomach started growling.Would you like to have dinner with me?he asked Latasha.She was walking to the dissecting table. After the autopsy is over, let's see the time before making a decision, she said without looking back. Jack found multiple polyps in Patience's large intestine.He put the dissected viscera back into the abdominal cavity.I have to praise Harold.A word from Langley.He gave Patience.The anti-corrosion treatment done by Stanhope is quite professional, almost catching up with the level of ancient Egypt. I don't have much contact with embalmed corpses.But the state of this corpse is better than I imagined, Latasha said and switched on the power of the bone saw.Bone saws are designed to cut through hard bone, not soft tissue, and vibrate when powered on.She tried it first.The bone saw rotated at high speed, making a harsh noise.She stood still in front of the embalming table and began to cut the skull.She had previously peeled off the scalp along Patience's face, exposing the skull. The noise was nothing to Jack.He pressed the liver to see if the cancer in the colon had metastasized to the liver, but he couldn't find it.He made several more incisions on the liver, but still found no abnormalities.He knew that a microscope might reveal the lesion, but that was all he could do now. Twenty minutes later, the two ruled out the possibility of major abnormalities in the brain, collected samples from various organs, and then turned their attention to the heart.Jack has had his lungs removed, and now all that remains is the heart on a stainless steel plate. It felt like saving the best gift for last, Jack said.He stared eagerly at the heart, curious in his eyes, wondering what secrets it would reveal.The volume of the heart is about the same as that of a larger orange. The muscle tissue is gray, but the fatty tissue on the top is light brown. Feeling like dessert, Latasha was thrilled too. Standing here looking at this heart reminds me of another case.About six months ago, a woman suddenly collapsed in a Bloomingdale's department store.Relying on an external cardiac pacemaker could not resuscitate her heart, and Patience.Stanhope is about the same. What was the conclusion of the autopsy? Severe formative posterior descending coronary artery constriction.The thrombus blocked most of the cardiac conduction system, killing him instantly. Do you think Patience has this problem too? Possibly, Jack said.But I think there is also some sort of diaphragmatic defect causing a right to left atrial shunt which manifests as cyanosis.Then he added, I still don't understand why anyone would try so hard to prevent us from discovering this. I think the autopsy might reveal extensive coronary artery disease.And maybe a couple of smaller, less obvious heart attacks before.In other words, her heart conduction system had serious problems before the final emergency, but it was not serious enough to be detected by a routine electrocardiogram. This idea is very interesting, Jack said and looked at Latasha across the dissecting table.She was still staring at the heart.He admired her more and more.If only she didn't look so freshman.Compared with her, he felt really old. By the way, recent studies have shown that the symptoms of coronary heart disease in postmenopausal women are different from those of male patients of the same age!The case you just mentioned just proved this point. Don't keep making me feel like an ignorant old-timer, Jack complained. Latasha waved her hand away.Well, stop talking!she announced with a smile. How about we make a bet.We're not in the office anyway, and the ban from the Forensic Medicine Department can't control us.I bet it's congenital, you bet it's degenerative.I'm willing to pay five dollars to bet on me winning. Yo, it's a generous shot!Latasha is also excited.Five dollars is a lot, but I'd double it up and bet ten. All right, said Jack.He turned the heart over, took tweezers and scissors, and began to dissect it.With Latasha holding the heart, Jack opened the heart along the right coronary artery, focusing on the right descending artery.He checked all the places the scissors could cut, then straightened up and stretched his back. There was no contraction, and he looked surprised and disappointed.Although he has always been relatively open-minded in terms of diagnosis, he does not want to preconceive and miss the real cause.But this time he was pretty sure of his pre-diagnosed cause of death.The right coronary artery provides most of the blood needed by the heart's conduction system.Patience.Stanhope had a heart attack and the part was definitely ruined. Don't lose heart yet, Latasha said.The ten dollars may still be yours.There was no shrinkage, but I didn't see atherosclerotic plaque either. You're right, the interior is pretty clean, Jack said.He still couldn't believe it, the whole blood vessel was basically normal. Jack turned his attention to the left coronary artery and its branches.But after a few minutes of dissection, it was found that the situation on the left side was similar to that on the right side, with neither plaque nor shrinkage.He was confused and disappointed.After so many setbacks, no obvious congenital or degenerative coronary artery abnormalities were found.He felt it was an insult to him personally. The cause of death must lie within the heart, Latasha said.It may be found that there are warts on the mitral valve or aortic valve, which will cause thrombus to erupt, and then metabolize clean. Jack nodded, but he was wondering how likely it was to have a sudden myocardial infarction and die without symptoms of coronary heart disease.He felt that this possibility was extremely small, definitely less than ten percent.But the present example proves that it is absolutely possible.The hallmark of forensic pathology is that it always allows one to see and learn something new. Latasha patted Jack who was in a daze, and handed him a long-bladed knife.cheer up!Take a look inside the heart. Jack opened the two atria and the two ventricles one by one, and made a series of incisions in the muscle wall.He and Latasha examined the valves, the partitions on the left and right sides of the heart, and the myocardium.The two worked quietly, checking each part systematically.After the examination, the two looked at each other across the dissecting table. On the bright side, neither of us lost ten dollars, and Jack wanted to liven things up.The downside is that Patience is still keeping the secret.He was famous for being uncooperative when he was alive, and he didn't change his temper after death. It was surprising how normal the heart was compared to her medical history, Latasha said.I've never seen this happen.We may have to wait for microscope observation before drawing conclusions.Perhaps some kind of capillary lesion involving only the smallest blood vessels of the coronary system. Never heard of it. Neither have I, Latasha said.But she must have died of a severe heart attack.The pathological signs we can find should be more than this asymptomatic colon cancer.Wait a moment!What is the name of that syndrome where the coronary arteries spasm?Named after a physician.She gestured to Jack as if she were playing a guessing game, waiting for Jack to come up with a name. I really have no idea.Don't say an uncommon word, it will make me feel that I am ignorant. Prinz Myto!This is it!Latasha shouted triumphantly.Prinz Mytor variant angina. Never heard of it, Jack said.You remind me of the defendant in this lawsuit, my brother-in-law.He must know.Could this spasm cause a serious heart attack?This is the most important question. It can't be variant angina, Latasha waved her hand suddenly and said.Coronary artery spasm also causes constriction of nearby blood vessels, so that we can also see obvious signs of pathology.But it didn't appear here. I'm relieved, said Jack. No matter what, the cause of death must be found out. I think so too.But nothing was found in the heart, and I was really confused, even a little embarrassed.It took so much effort to arrange an autopsy. I have an idea, Latasha said.Take the samples to my office.This allows observation of the heart with a stereo dissecting microscope.Frozen sections of heart tissue can also be made to observe capillaries.Other samples are processed according to normal procedures. Maybe we should go to dinner, Jack suddenly felt like giving up, not caring about anything. On the way back to the office, grab some pizza.cheer up!It's fun.Such a big secret, let's see if we can find the answer.Maybe even a toxicology test tonight.I happened to know the night shift administrator of a university lab.We've been in love before.It didn't work out, but we were still acquaintances. Jack's ears perked up.Say it again?He couldn't believe it.Can do toxicology test tonight?At the New York State Medical Examiner, getting results in a week is not bad. Yes.But we have to wait until after eleven o'clock, when Alan.Smithson had just started working the evening shift. Allen.Who is Smithson?Jack asked.If the toxicology test can be done immediately, the depth of the investigation will not be the same. We met in college.The two took many courses related to chemistry and biology.Then I went to medical school and he went to graduate school.We now work only a few blocks apart. So you don't have a beauty sleep? Save that for tomorrow night.I am now addicted to this case.We must save your brother-in-law from the evil lawyer.