The Surgeon r-1

  The Surgeon

  ( Rizzoli-Isles - 1 )

  Tess Gerritsen

  In Boston, there’s a killer on the loose. A killer who targets lone women, who breaks into their apartments and performs terrifying ritualistic acts of torture on his victims before finishing them off. His surgical skills lead police to suspect he is a physician — a physician who, instead of saving lives, takes them.

  But as homicide detective Thomas Moore and his partner Jane Rizzoli begin their investigation, they make a startling discovery. Closely linked to these killings is Catherine Cordell, a beautiful medic with a mysterious past. Two years ago she was subjected to a horrifying rape and attempted murder but shot her attacker dead. Now she is being targeted by this new killer who seems to know all about her past, her work at the Pilgrim Medical Center, and where she lives.

  The man she believes she killed seems to be stalking her once again, and this time he knows exactly where to find her…

  Tess Gerritsen

  The Surgeon

  ACKNOWLEDGMENTS

  I owe a very special thanks to:

  Bruce Blake and Detective Wayne R. Rock of the Boston Police Department, and to Chris Michalakes, M.D., for their technical assistance.

  Jane Berkey, Don Cleary, and Andrea Cirillo for their helpful comments on the first draft.

  My editor, Linda Marrow, for gently pointing the way.

  My guardian angel, Meg Ruley. (Every writer needs a Meg Ruley!)

  And to my husband, Jacob. Always, to Jacob.

  Prologue

  Today they will find her body.

  I know how it will happen. I can picture, quite vividly, the sequence of events that will lead to the discovery. By nine o’clock, those snooty ladies at the Kendall and Lord Travel Agency will be sitting at their desks, their elegantly manicured fingers tapping at computer keyboards, booking a Mediterranean cruise for Mrs. Smith, a ski vacation at Klosters for Mr. Jones. And for Mr. and Mrs. Brown, something different this year, something exotic, perhaps Chiang Mai or Madagascar, but nothing too rugged; oh no, adventure must, above all, be comfortable. That is the motto at Kendall and Lord: “Comfortable adventures.” It is a busy agency, and the phone rings often.

  It will not take long for the ladies to notice that Diana is not at her desk.

  One of them will call Diana’s Back Bay residence, but the phone will ring, unanswered. Maybe Diana is in the shower and can’t hear it. Or she has already left for work but is running late. A dozen perfectly benign possibilities will run through the caller’s mind. But as the day wears on, and repeated calls go unanswered, other, more disturbing possibilities, will come to mind.

  I expect it’s the building superintendent who will let Diana’s coworker into the apartment. I see him nervously rattling his keys as he says, “You’re her friend, right? You sure she won’t mind? ’Cause I’m gonna have to tell her I let you in.”

  They walk into the apartment, and the coworker calls out: “Diana? Are you home?” They start up the hall, past the elegantly framed travel posters, the superintendent right behind her, watching that she doesn’t steal anything.

  Then he looks through the doorway, into the bedroom. He sees Diana Sterling, and he is no longer worried about something as inconsequential as theft. He wants only to get out of that apartment before he throws up.

  I would like to be there when the police arrive, but I am not stupid. I know they will study every car that creeps by, every face that stares from the gathering of spectators on the street. They know my urge to return is strong. Even now, as I sit in Starbucks, watching the day brighten outside the window, I feel that room calling me back. But I am like Ulysses, safely lashed to my ship’s mast, yearning for the sirens’ song. I will not dash myself against the rocks. I will not make that mistake.

  Instead I sit and drink my coffee while outside, the city of Boston comes awake. I stir three teaspoons of sugar into my cup; I like my coffee sweet. I like everything to be just so. To be perfect.

  A siren screams in the distance, calling to me. I feel like Ulysses straining against the ropes, but they hold fast.

  Today they will find her body.

  Today they will know we are back.

  One

  One year later

  Detective Thomas Moore disliked the smell of latex, and as he snapped on the gloves, releasing a puff of talcum, he felt the usual twinge of anticipatory nausea. The odor was linked to the most unpleasant aspects of his job, and like one of Pavlov’s dogs, trained to salivate on cue, he’d come to associate that rubbery scent with the inevitable accompaniment of blood and body fluids. An olfactory warning to brace himself.

  And so he did, as he stood outside the autopsy room. He had walked in straight from the heat, and already sweat was chilling on his skin. It was July 12, a humid and hazy Friday afternoon. Across the city of Boston, air conditioners rattled and dripped, and tempers were flaring. On the Tobin Bridge, cars would already be backed up, fleeing north to the cool forests of Maine. But Moore would not be among them. He had been called back from his vacation, to view a horror he had no wish to confront.

  He was already garbed in a surgical gown, which he’d pulled from the morgue linen cart. Now he put on a paper cap to catch stray hairs and pulled paper booties over his shoes, because he had seen what sometimes spilled from the table onto the floor. The blood, the clumps of tissue. He was by no means a tidy man, but he had no wish to bring any trace of the autopsy room home on his shoes. He paused for a few seconds outside the door and took a deep breath. Then, resigning himself to the ordeal, he pushed into the room.

  The draped corpse lay on the table — a woman, by the shape of it. Moore avoided looking too long at the victim and focused instead on the living people in the room. Dr. Ashford Tierney, the Medical Examiner, and a morgue attendant were assembling instruments on a tray. Across the table from Moore stood Jane Rizzoli, also from the Boston Homicide Unit. Thirty-three years old, Rizzoli was a small and square-jawed woman. Her untamable curls were hidden beneath the paper O.R. cap, and without her black hair to soften her features, her face seemed to be all hard angles, her dark eyes probing and intense. She had transferred to Homicide from Vice and Narcotics six months ago. She was the only woman in the homicide unit, and already there had been problems between her and another detective, charges of sexual harassment, countercharges of unrelenting bitchiness. Moore was not sure he liked Rizzoli, or she him. So far they had kept their interactions strictly business, and he thought she preferred it that way.

  Standing beside Rizzoli was her partner, Barry Frost, a relentlessly cheerful cop whose bland and beardless face made him seem much younger than his thirty years. Frost had worked with Rizzoli for two months now without complaint, the only man in the unit placid enough to endure her foul moods.

  As Moore approached the table, Rizzoli said, “We wondered when you’d show up.”

  “I was on the Maine Turnpike when you beeped me.”

  “We’ve been waiting here since five.”

  “And I’m just starting the internal exam,” Dr. Tierney said. “So I’d say Detective Moore got here right on time.” One man coming to the defense of another. He slammed the cabinet door shut, setting off a reverberating clang. It was one of the rare occasions he allowed his irritation to show. Dr. Tierney was a native Georgian, a courtly gentleman who believed ladies should behave like ladies. He did not enjoy working with the prickly Jane Rizzoli.

  The morgue attendant wheeled a tray of instruments to the table, and his gaze briefly met Moore’s with a look of, Can you believe this bitch?

  “Sorry about your fishing trip,” Tierney said to Moore. “It looks like your vacation’s canceled.”

  “You’re sure it’s our boy again?”


  In answer, Tierney reached for the drape and pulled it back, revealing the corpse. “Her name is Elena Ortiz.”

  Though Moore had been braced for this sight, his first glimpse of the victim had the impact of a physical blow. The woman’s black hair, matted stiff with blood, stuck out like porcupine quills from a face the color of blue-veined marble. Her lips were parted, as though frozen in mid-utterance. The blood had already been washed off the body, and her wounds gaped in purplish rents on the gray canvas of skin. There were two visible wounds. One was a deep slash across the throat, extending from beneath the left ear, transecting the left carotid artery, and laying open the laryngeal cartilage. The coup de grace. The second slash was low on the abdomen. This wound had not been meant to kill; it had served an entirely different purpose.

  Moore swallowed hard. “I see why you called me back from vacation.”

  “I’m the lead on this one,” said Rizzoli.

  He heard the note of warning in her statement; she was protecting her turf. He understood where it came from, how the constant taunts and skepticism that women cops faced could make them quick to take offense. In truth he had no wish to challenge her. They would have to work together on this, and it was too early in the game to be battling for dominance.

  He was careful to maintain a respectful tone. “Could you fill me in on the circumstances?”

  Rizzoli gave a curt nod. “The victim was found at nine this morning, in her apartment on Worcester Street, in the South End. She usually gets to work around six A.M. at Celebration Florists, a few blocks from her residence. It’s a family business, owned by her parents. When she didn’t show up, they got worried. Her brother went to check on her. He found her in the bedroom. Dr. Tierney estimates the time of death was somewhere between midnight and four this morning. According to the family, she had no current boyfriend, and no one in her apartment building recalls seeing any male visitors. She’s just a hardworking Catholic girl.”

  Moore looked at the victim’s wrists. “She was immobilized.”

  “Yes. Duct tape on the wrists and ankles. She was found nude. Wearing only a few items of jewelry.”

  “What jewelry?”

  “A necklace. A ring. Ear studs. The jewelry box in the bedroom was untouched. Robbery was not the motive.”

  Moore looked at the horizontal band of bruising across the victim’s hips. “The torso was immobilized as well.”

  “Duct tape across the waist and the upper thighs. And across her mouth.”

  Moore released a deep breath. “Jesus.” Staring at Elena Ortiz, Moore had a disorienting flash of another young woman. Another corpse — a blonde, with meat-red slashes across her throat and abdomen.

  “Diana Sterling,” he murmured.

  “I’ve already pulled Sterling’s autopsy report,” said Tierney. “In case you need to review it.”

  But Moore did not; the Sterling case, on which he had been lead detective, had never strayed far from his mind.

  A year ago, thirty-year-old Diana Sterling, an employee at the Kendall and Lord Travel Agency, had been discovered nude and strapped to her bed with duct tape. Her throat and lower abdomen were slashed. The murder remained unsolved.

  Dr. Tierney directed the exam light onto Elena Ortiz’s abdomen. The blood had been rinsed off earlier, and the edges of the incision were a pale pink.

  “Trace evidence?” asked Moore.

  “We picked off a few fibers before we washed her off. And there was a strand of hair, adhering to the wound margin.”

  Moore looked up with sudden interest. “The victim’s?”

  “Much shorter. A light brown.”

  Elena Ortiz’s hair was black.

  Rizzoli said, “We’ve already requested hair samples from everyone who came into contact with the body.”

  Tierney directed their attention to the wound. “What we have here is a transverse cut. Surgeons call this a Maylard incision. The abdominal wall was incised layer by layer. First the skin, then the superficial fascia, then the muscle, and finally the pelvic peritoneum.”

  “Like Sterling,” said Moore.

  “Yes. Like Sterling. But there are differences.”

  “What differences?”

  “On Diana Sterling, there were a few jags in the incision, indicating hesitation, or uncertainty. You don’t see that here. Notice how cleanly this skin has been incised? There are no jags at all. He did this with absolute confidence.” Tierney’s gaze met Moore’s. “Our unsub is learning. He’s improved his technique.”

  “If it’s the same unknown subject,” Rizzoli said.

  “There are other similarities. See the squared-off margin at this end of the wound? It indicates the track moves from right to left. Like Sterling. The blade used in this wound is single-edged, nonserrated. Like the blade used on Sterling.”

  “A scalpel?”

  “It’s consistent with a scalpel. The clean incision tells me there was no twisting of the blade. The victim was either unconscious, or so tightly restrained she couldn’t move, couldn’t struggle. She couldn’t cause the blade to divert from its linear path.”

  Barry Frost looked like he wanted to throw up. “Aw, jeez. Please tell me she was already dead when he did this.”

  “I’m afraid this is not a postmortem wound.” Only Tierney’s green eyes showed above the surgical mask, and they were angry.

  “There was antemortem bleeding?” asked Moore.

  “Pooling in the pelvic cavity. Which means her heart was still pumping. She was still alive when this… procedure was done.”

  Moore looked at the wrists, encircled by bruises. There were similar bruises around both ankles, and a band of petechiae — pinpoint skin hemorrhages — stretched across her hips. Elena Ortiz had struggled against her bonds.

  “There’s other evidence she was alive during the cutting,” said Tierney. “Put your hand inside the wound, Thomas. I think you know what you’re going to find.”

  Reluctantly Moore inserted his gloved hand into the wound. The flesh was cool, chilled from several hours of refrigeration. It reminded him of how it felt to thrust his hand into a turkey carcass and root around for the package of giblets. He reached in up to his wrist, his fingers exploring the margins of the wound. It was an intimate violation, this burrowing into the most private part of a woman’s anatomy. He avoided looking at Elena Ortiz’s face. It was the only way he could regard her mortal remains with detachment, the only way he could focus on the cold mechanics of what had been done to her body.

  “The uterus is missing.” Moore looked at Tierney.

  The M.E. nodded. “It’s been removed.”

  Moore withdrew his hand from the body and stared down at the wound, gaping like an open mouth. Now Rizzoli thrust her gloved hand in, her short fingers straining to explore the cavity.

  “Nothing else was removed?” she asked.

  “Just the uterus,” said Tierney. “He left the bladder and bowel intact.”

  “What’s this thing I’m feeling here? This hard little knot, on the left side,” she said.

  “It’s suture. He used it to tie off blood vessels.”

  Rizzoli looked up, startled. “This is a surgical knot?”

  “Two-oh plain catgut,” ventured Moore, looking at Tierney for confirmation.

  Tierney nodded. “The same suture we found in Diana Sterling.”

  “Two-oh catgut?” asked Frost in a weak voice. He had retreated from the table and now stood in a corner of the room, ready to bolt for the sink. “Is that like a — a brand name or something?”

  “Not a brand name,” said Tierney. “Catgut is a type of surgical thread made from the intestines of cows or sheep.”

  “So why do they call it catgut?” asked Rizzoli.

  “It goes back to the Middle Ages, when gut strings were used on musical instruments. The musicians referred to their instruments as their kit, and the strings were called kitgut. The word eventually became catgut. In surgery, this sort of suture is used to s
ew together deep layers of connective tissue. The body eventually breaks down the suture material and absorbs it.”

  “And where would he get this catgut suture?” Rizzoli looked at Moore. “Did you trace a source for it on Sterling?”

  “It’s almost impossible to identify a specific source,” said Moore. “Catgut suture’s manufactured by a dozen different companies, most of them in Asia. It’s still used in a number of foreign hospitals.”

  “Only foreign hospitals?”

  Tierney said, “There are now better alternatives. Catgut doesn’t have the strength or durability of synthetic sutures. I doubt many surgeons in the U.S. are currently using it.”

  “Why would our unsub use it at all?”

  “To maintain his visual field. To control the bleeding long enough so he can see what he’s doing. Our unsub is a very neat man.”

  Rizzoli pulled her hand from the wound. In her gloved palm was cupped a tiny clot of blood, like a bright red bead. “How skillful is he? Are we dealing with a doctor? Or a butcher?”

  “Clearly he has anatomical knowledge,” said Tierney. “I have no doubt he’s done this before.”

  Moore took a step backward from the table, recoiling from the thought of what Elena Ortiz must have suffered, yet unable to keep the images at bay. The aftermath lay right in front of him, staring with open eyes.

  He turned, startled, as instruments clattered on the metal tray. The morgue attendant had pushed the tray next to Dr. Tierney, in preparation for the Y-incision. Now the attendant leaned forward and stared into the abdominal wound.

  “So what happens to it?” he asked. “Once he whacks out the uterus, what does he do with it?”

  “We don’t know,” said Tierney. “The organs have never been found.”

  Two

  Moore stood on the sidewalk in the South End neighborhood where Elena Ortiz had died. Once this had been a street of tired rooming houses, a shabby backwater neighborhood separated by railroad tracks from the more desirable northern half of Boston. But a growing city is a ravening creature, always in search of new land, and railroad tracks are no barrier to the hungry gaze of developers. A new generation of Bostonians had discovered the South End, and the old rooming houses were gradually being converted to apartment buildings.