Chapter Text
It is the responsibility of the medical examiner to tell the last story a person needs to tell.
This is what your advisor told you on the first day of your forensic pathology fellowship and it’s what goes through your head in cases like this one. The cases that puzzle you, the cases that make your stomach feel like maggots are gnawing a hole into it.
The decedent is a woman. She’s young, only a year older than you, and she was found dead in her bed by her cellmate in an Arkham holding cell. Other than a puckered pink scar on the skin behind her chin and the freckles that dust her nose and shoulders, her skin is blemish free and smooth as porcelain. There’s no sign of track marks, no bruising around her neck, she doesn’t even have bumps on her knees or elbows that are commonly acquired in childhood from falling off bikes or scooters. You can’t see or feel any swelling in her abdomen and note no hepatomegaly or splenomegaly - swelling of liver or spleen.
For a moment you gaze at the round cherubic face of the woman on your table. The inside border of her small, heart-shaped lips have the blue hypoxic hue that all decedents do. What would she tell you if she could talk?
What is your story, Dr. Jones?
“I’m ready with the scalpel when you are, doctor.” Your tech today is Jed, a young pre-med student. Jed’s appearance and personality is generic and unmemorable, a stock photo of a person, but he is an efficient and thorough worker.
“Pictures taken?”
When he nods, you put on your face shield and reach across the table to take the scalpel from him. Jed has drawn on the Y for you with faint dotted lines. The two arms extending out right beneath Dr. Jones’ breasts and up to her shoulder joints.
You’re not sure if he does this with the other medical examiners in the Office of the Chief Medical Examiner of the City of Gotham (or OCME Gotham for short), but you decide not to take offense. First, because you still like the lines. They give you something to focus on. When you’re following lines you can pretend you’re just connecting the dots to make a picture instead of opening a body. Second, because you are the newest and most inexperienced ME in the office and you, truthfully, probably still need the lines.
“Saw?” he asks.
“Saw.” You concur. While handing him the scalpel you crook your neck awkwardly to scratch an itch on your ear with the shoulder of the light blue polyethylene disposable gown you wear over your scrubs. Scratching an itch with soiled gloves is a mistake you only need to make once.
After five years of training plus eight months on the job, the weight of the bone saw in your palm is as familiar as the hand of a loved one. You don’t even need to look at it to turn it on and feel it come to life in your grip. It’s been years since you’ve shivered at the way the vibrations travel through your arm when meeting the resistance of the bone or recoiled at the crack of the breastplate being forced open.
As soon as you get a look inside of Dr. Jones’ thoracic cavity, you are pretty sure you know what her cause of death is. Black-maroon, semi-congealed blood surrounds her healthy pink, deflated lungs in clumps, like a gelatinous packing peanuts.
Before you hold your hand out for the scalpel, you take a step back and allow Jed to take a picture. This is one of the reasons why you like working with Jed, some techs get annoyed by your by-the-book methods of doing an autopsy, but he seems to be as naturally thorough as you.
“Do you think it’s another one?” He asks as you slice the soft tissue between the cartilaginous rings on the left primary bronchi, detaching the lung.
“It sure looks like it from here, doesn’t it?”
He takes the lung from you, keeping his eyes fixated on the sac that holds the heart until he turns away to weigh the organ.
“What are the odds?” he huffs over his shoulder.
“I don’t know. Pretty low.”
The temperature of a dead body used to be deeply unsettling to you. Now, you barely noticed as you slide some cold, gooey blood off of the fibrous tissue that makes up the outside of the pericardium with your gloved fingers.
The heart is like a present wrapped in three layers of tissue and you systematically cut and fold back each layer one at a time, working slowly to make sure you don’t lacerate the actual heart with your scalpel in the process.
“Gross inspection of pericardium. All three layers appear healthy with minimal to no inflammation,” you press your chin down and mumble into the small recorder attached to the front of your gown.
You remember the first time you saw a human heart on a field trip in middle school. It’d shocked you how small it was. How could something so vital for survival be no larger than your two fists put together? How could a muscle of this size generate enough force to supply your whole body with blood?
It takes more swiping and clearing of congealed blood before you locate the rupture. “Type A aortic dissection, right near the root of the ascending aorta.”
Hearing your words, Jed abandons the lung on the aluminum dissecting tray and walks over to the body, leaning over and peering down at the hole that has torn through the largest artery in the body.
“Another sudden cardiac death?” He asks.
You nod, stepping back to look at the body opened on your table.
“Did you see anything about previous heart problems in her file?”
“No, but I just skimmed it.” Jed is taking pictures of Sadie Jones’ heart with the official autopsy camera.
“Me too.” You admit.
The OCME Gotham receives an average of nine thousand bodies a year. That’s seven hundred and fifty bodies a month, or twenty five bodies a day. Because of recent budget cuts, you’re severely understaffed for a city this size, with only twenty two medical examiners and fifty mortuary technicians. This means everyone is either feeling overworked, underappreciated, and bitter, or they’ve given up and do the bare minimum.
A wave of exhaustion and frustration crashes over you and you ball your hands into fists to resist an urge to slide them down your face. Assuming that you’re able to rule out all other causes, Dr. Jones will be the third woman in less than two months on your table who will have SCD (sudden cardiac death) by aortic dissection listed as her cause of death. And if her case is anything like the others, she’ll have no signs of any pre-existing heart condition, no congenital abnormalities, no elastic tissue defects, and no external chest trauma.
The rest of the autopsy passes without a hitch. Her liver and kidneys are beautiful specimens. They don’t even show the usual wear and tear common of a woman her age from the occasional overindulgence of alcohol or over-the-counter pain medications. Her lungs are clear and pristine, and her blood vessels damage free. Preliminary toxicology comes back clean and from the state of her organs you’d be shocked if the more in-depth reports would come back with anything suspicious.
For a moment, you gaze at the crown of her head. Then you snap off your gloves, pull off your gown and shield, and head straight to Ron’s office.
.
.
.
Dr. Ronald Major has the kind of face that a caricature artist would love. The way the end of his bulbous nose peeks out over the top of his big salt and pepper moustache and the bushy eyebrows that dominate his heavy brow brings to mind a Yosemite Sam or maybe a Captain Hook.
When Ron (as he prefers his staff to call him) looks up from his paperwork to see you walking in, his already weary face slumps. It’s not that the chief medical examiner is unfriendly, he’s simply under a lot of pressure. The man puts the CME in the OCME Gotham and as such bears the responsibility for the aforementioned nine thousand bodies a year. To say he’s bone-tired would be an understatement.
“Make it quick, Smallville. The charity ball is tonight and I’ve got more work to do than a sex worker on dime night.” He says by way of greeting.
Even though he can be a grouchy bastard, and his manner of speaking can be… well, offensive to say the least, his constant use of inappropriate and sometimes confusing idioms reminds you of your family back home.
The top of his desk is hidden by a small mountain range of paperwork and you place your laptop on the peak of one of the stacks. You turn the computer at an angle and lean over so you can both see the file you have pulled up.
After several seconds of scrolling through what you’ve assembled on Sadie Jones, he grumbles, “What am I looking at here? It seems to me like an open and shut case.”
“A perfectly healthy young woman with no reported history of heart issues, no physical evidence of heart issues, dies of a freak aortic dissection two days before she’s supposed to testify against the Falcone family? This is what you’d call an ‘open and shut’ case?”
“Did you find anything else on the body? Any marks to suggest foul play?”
The question is rhetorical. He read the summary of your findings and knows as well as you do that you didn’t, but you answer anyway, “No. But this is the third body on my table like this in less than two months, Ron. Aortic dissection without any previous indication is... extremely rare.” You want to say ‘unheard of’ but know better than that. One of the first lessons you learned in medical school is nothing is ‘unheard of.’
“In a city as big as Gotham, the ‘extremely rare’ can seem disproportionately represented, Smallville.” Perhaps he calls you by the name of your hometown to remind you of your humble beginnings in cases such as these, but he’s also used it in an endearing context, so you try not to let it get under your skin. Yet you can feel yourself flush, your confidence starting to waver.
“Still. Are we just supposed to ignore the fact that she drops dead right before a hearing?”
“That isn’t our job. We’re not detectives.”
“Aren’t we though? Isn’t it our job to investigate the cause of death?”
Ron groans and pinches the bridge of his nose. You feel guilty and can hear your mother’s voice telling you to ‘stop being a pain in the ass,’ but then you remember the way Sadie’s strawberry blonde curls gleamed under the fluorescent lights like expensive rose gold. You think back to the full lips and rich chestnut skin of the woman a few weeks back and the perfectly manicured nails, with tiny daisies painted on the thumbs, of the one before her. These women deserve an explanation.
“Do you know what Dr. Jones did?”
When you don’t respond he continues, “Sadie Jones assisted a convicted murderer’s escape from Arkham, she helped him kidnap and torture her colleague and friend. In addition, she’s been implicated in unethical research, and extortion.”
You tilt your chin up stubbornly, “Does it matter? It’s not my job to pass judgement. It’s my job to figure out how they died. If there’s a disease or something more… nefarious out there that’s making people drop dead, it’s our responsibility to alert the public, isn’t it?”
“We already have enough on our table. The last thing we need is a starry-eyed medical examiner straight out of residency who thinks she can change the world unnecessarily complicating uncomplicated deaths.”
The flinch at Ron’s words is reflexive, and unfortunately, he sees it. His face softens and you hate that you made yourself look so fragile.
Not only are you one of only six female medical examiners working in the OCME, but you’re the youngest by almost a decade. To be taken seriously you actively hide your accent, have stopped smiling as much, and have thrown out any colorful clothing. Even after all that, you’re still here, being looked at with those sympathetic ‘oh honey’ eyes.
It makes you want to scream. It makes you want to cry. It makes you want to scream that it makes you want to cry.
“Listen, Smallville, I know you mean well. I do. But you’re playing in the big leagues now and the quicker you learn to not draw conclusions where there aren’t any, the better. To the rest of the world Gotham looks like a city of villains where every other death is a homicide, but that’s not the case.”
You have more to say, but you don’t trust yourself not to cry, so you firm your jaw and nod.
“Atta girl.” Ron pats your hand, making you feel tiny and like a child.
Before you can leave his office he reminds you about the NYE Charity Ball for GCPD tonight. “Bruce Wayne is supposed to be there, and we need all hands on deck to charm his pants off. We need that money of his.”
And when you walk back to your desk you wonder if Ron realizes how wrong what he said could be taken. You know he means well, that he wouldn’t ever suggest you use some sort of seduction on Bruce Wayne to get his money. He’s just a man from the good ol’ boy generation who doesn’t understand that if he’s not careful he could get himself into trouble one day.