The Surgeon Read online

  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.

  Elena Ortiz lived in just such a building. Though the views from her second-story apartment were uninspiring—her windows faced a Laundromat across the street—the building did offer a treasured amenity rarely found in the city of Boston: tenant parking, crammed into the adjacent alley.

  Moore walked down that alley now, scanning the windows in the apartments above, wondering who at that moment was looking down at him. Nothing moved behind the windows’ glassy eyes. The tenants facing this alley had already been interviewed; none had offered any useful information.

  He stopped beneath Elena Ortiz’s bathroom window and stared up at the fire escape leading to it. The ladder was pulled up and latched in the retracted position. On the night Elena Ortiz died, a tenant’s car had been parked just beneath the fire escape. Size 8 1/2 shoe prints were later found on the car’s roof. The unsub had used it as a stepping-stone to reach the fire escape.

  He saw that the bathroom window was shut. It had not been shut the night she met her killer.

  He left the alley, circled back to the front entrance, and let himself into the building.

  Police tape hung in limp streamers across Elena Ortiz’s apartment door. He unlocked the door and fingerprint powder rubbed off like soot on his hand. The loose tape slithered across his shoulders as he stepped into the apartment.

  The living room was as he remembered it from his walk-through the day before, with Rizzoli. It had been an unpleasant visit, simmering with undercurrents of rivalry. The Ortiz case had started off with Rizzoli as lead, and she was insecure enough to feel threatened by anyone challenging her authority, especially an older male cop. Though they were now on the same team, a team that had since expanded to five detectives, Moore felt like a trespasser on her turf, and he’d been careful to couch his suggestions in the most diplomatic terms. He had no wish to engage in a battle of egos, yet a battle was what it had become. Yesterday he’d tried to focus on this crime scene, but her resentment kept pricking his bubble of concentration.

  Only now, alone, could he completely focus his attention on the apartment where Elena Ortiz had died. In the living room he saw mismatched furniture arranged around a wicker coffee table. A desktop computer in the corner. A beige rug patterned with leafy vines and pink flowers. Since the murder, nothing had been moved, nothing altered, according to Rizzoli. The last light of day was fading in the window, but he did not turn on the lights. He stood for a long time, not even moving his head, waiting for complete stillness to fall across the room. This was the first chance he’d had to visit the scene alone, the first time he’d stood in this room undistracted by the voices, the faces, of the living. He imagined the molecules of air, briefly stirred by his entry, now slowing, drifting. He wanted the room to speak to him.

  He felt nothing. No sense of evil, no lingering tremors of terror.

  The unsub had not come in through the door. Nor had he gone wandering through his newly claimed kingdom of death. He had focused all his time, all his attention, on the bedroom.

  Moore walked slowly past the tiny kitchen and started up the hallway. He felt the hairs on the back of his neck begin to bristle. At the first doorway he paused and stared into the bathroom. He turned on the light.

  Thursday is a warm night. It is so warm that all across the city, windows are left open to catch every stray breeze, every cool breath of air. You crouch on the fire escape, sweating in your dark clothes, staring into this bathroom. There is no sound; the woman is asleep in the bedroom. She has to be up early for her job at the florist’s, and at this hour her sleep cycle is passing into its deepest, most unarousable phase.

  She doesn’t hear the scratch of your putty knife as you pry open the screen.

  Moore looked at the wallpaper, adorned with tiny red rosebuds. A woman’s pattern, nothing a man would choose. In every way this was a woman’s bathroom, from the strawberry-scented shampoo, to the box of Tampax under the sink, to the medicine cabinet crammed with cosmetics. An aqua-eye-shadow kind of gal.

  You climb in the window, and fibers of your navy-blue shirt catch on the frame. Polyester. Your sneakers, size 8 1/2, leave prints coming in on the white linoleum floor. There are traces of sand, mixed with crystals of gypsum. A typical mix picked up from walking the city of Boston.

  Maybe you pause, listening in the darkness. Inhaling the sweet foreignness of a woman’s space. Or maybe you waste no time but proceed straight to your goal.

  The bedroom.

  The air seemed fouler, thicker, as he followed in the intruder’s footsteps. It was more than just an imagined sense of evil; it was the smell.

  He came to the bedroom door. By now the hairs on the back of his neck were standing straight out. He already knew what he would see inside the room; he thought he was prepared for it. Yet when he turned on the lights, the horror assailed him once again, as it had the first time he’d seen this room.

  The blood was now over two days old. The cleaning service had not yet come in. But even with their detergents and steam cleaners and cans of white paint, they could never fully erase what had happened here, because the air itself was permanently imprinted with terror.

  You step through the doorway, into this room. The curtains are thin, only an unlined cotton print, and light from the street lamps shines through the fabric, onto the bed. Onto the sleeping woman. Surely you must linger a moment, studying her. Considering with pleasure the task that lies ahead. Because it is pleasurable for you, isn’t it? You are growing more and more excited. The thrill moves through your bloodstream like a drug, awakening every nerve, until even your fingertips are pulsing with anticipation.

  Elena Ortiz did not have time to scream. Or, if she did, no one heard her. Not the family in the unit next door, nor the couple below.

  The intruder brought his tools with him. Duct tape. A rag soaked in chloroform. A collection of surgical instruments. He had come fully prepared.

  The ordeal would have lasted well over an hour. Elena Ortiz was conscious for at least part of that time. The skin on her wrists and ankles was chafed, indicating she had struggled. In her panic, her agony, she had emptied her bladder, and urine had soaked into the mattress, mingling with her blood. The operation was a delicate one, and he took the time to do it right, to take only what he wanted, nothing more.

  He did not rape her; perhaps he was incapable of doing so.

  When he’d finished his terrible excision, she was still alive. The pelvic wound continued to bleed, the heart to pump. How long? Dr. Tierney had guessed at least half an hour. Thirty minutes, which must have seemed an eternity to Elena Ortiz.

  What were you doing during that time? Putting your tools away? Packing your prize in a jar? Or did you merely stand here, enjoying the view?

  The final act was swift and businesslike. Elena Ortiz’s tormentor had taken what he wanted, and now it was time to finish things. He’d moved to the head of the bed. With his left hand he’d grasped a handful of her hair, yanking backward so hard he tore out more than two dozen strands. These were found later, scattered on the pillow and floor. The bloodstains
shrieked out the final events. With her head immobilized and the neck fully exposed, he’d made a single deep slash starting at the left jaw and moving rightward, across the throat. He had severed the left carotid artery and the trachea. Blood spurted. On the wall to the left of the bed were dense clusters of small circular drops flowing downward, characteristic of arterial spray as well as exhalation of blood from the trachea. The pillow and sheets were saturated from downward dripping. Several cast-off droplets, thrown off as the intruder swung away the blade, had spattered the windowsill.

  Elena Ortiz had lived long enough to see her own blood spurt from her neck and hit the wall in a machine-gun spray of red. She had lived long enough to aspirate blood into her severed trachea, to hear it gurgle in her lungs, to cough it out in explosive bursts of crimson phlegm.

  She had lived long enough to know she was dying.

  And when it was done, when her agonal struggles had ceased, you left us a calling card. You neatly folded the victim’s nightshirt, and you left it on the dresser. Why? Is it some twisted sign of respect for the woman you’ve just slaughtered? Or is it your way of mocking us? Your way of telling us that you are in control?

  Moore returned to the living room and sank into an armchair. It was hot and airless in the apartment, but he was shivering. He didn’t know if the chill was physical or emotional. His thighs and shoulders ached, so maybe it was just a virus coming on. A summer flu, the worst kind. He thought of all the places he’d rather be at that moment. Adrift on a Maine lake, his fishing line whicking through the air. Or standing at the seashore, watching the fog roll in. Anywhere but this place of death.

  The chirp of his beeper startled him. He shut it off and realized his heart was pounding. He made himself calm down first before he took out the cell phone and punched in the number.

  “Rizzoli,” she answered on the first ring, her greeting as direct as a bullet.

  “You paged me.”

  “You never told me you got a hit on VICAP,” she said.

  “What hit?”

  “On Diana Sterling. I’m looking at her murder book now.”

  VICAP, the Violent Criminals Apprehension Program, was a national database of homicide and assault information gathered from cases across the country. Killers often repeated the same patterns, and with this data investigators could link crimes committed by the same perpetrator. As a matter of routine, Moore and his partner at the time, Rusty Stivack, had initiated a search on VICAP.

  “We turned up no matches in New England,” said Moore. “We ran down every homicide involving mutilation, night entry, and duct tape bindings. Nothing fit Sterling’s profile.”

  “What about the series in Georgia? Three years ago, four victims. One in Atlanta, three in Savannah. All were in the VICAP database.”

  “I reviewed those cases. That perp is not our unsub.”

  “Listen to this, Moore. Dora Ciccone, age twenty-two, graduate student at Emory. Victim first subdued with Rohypnol, then restrained to the bed with nylon cord—”

  “Our boy here uses chloroform and duct tape.”

  “He sliced open her abdomen. Cut out her uterus. Performed a coup de grace—a single slash across the neck. And finally—get this—he folded her nightclothes and left them on a chair by the bed. I’m telling you, it’s too goddamn close.”

  “The Georgia cases are closed,” said Moore. “They’ve been closed for two years. That perp is dead.”

  “What if Savannah PD blew it? What if he wasn’t their killer?”

  “They had DNA to back it up. Fibers, hairs. Plus there was a witness. A victim who survived.”

  “Oh yeah. The survivor. Victim number five.” Rizzoli’s voice held a strangely taunting note.

  “She confirmed the perp’s identity,” said Moore.

  “She also conveniently shot him to death.”

  “So what, you want to arrest his ghost?”

  “Did you ever talk to that surviving victim?” Rizzoli asked.

  “No.”

  “Why not?”

  “What would be the point?”

  “The point is that you might’ve learned something interesting. Like the fact she left Savannah soon after that attack. And guess where she’s living now?”

  Through the hiss of the cell phone, he could hear the whoosh of his own pulse. “Boston?” he asked softly.

  “And you’re not gonna believe what she does for a living.”

  three

  Dr. Catherine Cordell sprinted down the hospital corridor, the soles of her running shoes squeaking on the linoleum, and pushed through the double doors into the emergency room.

  A nurse called out: “They’re in Trauma Two, Dr. Cordell!”

  “I’m there,” said Catherine, moving like a guided missile straight for Trauma Two.

  Half a dozen faces flashed her looks of relief as she stepped into the room. In one glance she took stock of the situation, saw jumbled instruments glittering on a tray, the IV poles with bags of Ringer’s lactate hanging like heavy fruit on steel-rod trees, blood-streaked gauze and torn packaging scattered across the floor. A rapid sinus rhythm twitched across the cardiac monitor—the electrical pattern of a heart racing to stay ahead of Death.

  “What’ve we got?” she asked as personnel moved aside to let her pass.

  Ron Littman, the senior surgical resident, gave her a rapid-fire report. “John Doe Pedestrian, hit-and-run. Rolled into the E.R. unconscious. Pupils are equal and reactive, lungs are clear, but the abdomen’s distended. No bowel sounds. BP’s down to sixty over zip. I did a paracentesis. He’s got blood in his belly. We’ve got a central line in, Ringer’s lactate wide open, but we can’t keep his pressure up.”

  “O neg and fresh frozen on the way?”

  “Should be here any minute.”

  The man on the table was stripped naked, every intimate detail mercilessly exposed to her gaze. He appeared to be in his sixties, already intubated and on a ventilator. Toneless muscles sagged in folds on gaunt limbs, and his ribs stood out like arching blades. A preexisting chronic illness, she thought; cancer would be her first guess. The right arm and hip were abraded and bloody from scraping across pavement. On his right lower chest a bruise formed a purple continent on the white parchment of skin. There were no penetrating wounds.

  She slipped on her stethoscope to verify what the resident had just told her. She heard no sounds in the belly. Not a growl, not a tinkle. The silence of traumatized bowel. Moving the stethoscope diaphragm to the chest, she listened for breath sounds, confirming that the endotracheal tube was properly placed and that both lungs were being ventilated. The heart battered like a fist against the chest wall. Her exam took only a matter of seconds, yet she felt as though she were moving in slow motion, that around her the room full of personnel stood frozen in time, awaiting her next action.

  A nurse called out: “I’m barely getting the systolic at fifty!”

  Time sprang ahead at a frightening pace.

  “Get me a gown and gloves,” said Catherine. “Open the laparotomy tray.”

  “What about taking him to the O.R.?” said Littman.

  “All rooms are in use. We can’t wait.” Someone tossed her a paper cap. Swiftly she tucked in her shoulder-length red hair and tied on a mask. A scrub nurse was already holding out a sterile surgical gown. Catherine slipped her arms into the sleeves and thrust her hands into gloves. She had no time to scrub, no time to hesitate. She was in charge, and John Doe was crashing on her.

  Sterile drapes were whisked onto the patient’s chest and pelvis. She grabbed hemostats from the tray and swiftly clamped the drapes in place, squeezing the steel teeth with a satisfying snap, snap.

  “Where’s that blood?” she called out.

  “I’m checking with the lab now,” said a nurse.

  “Ron, you’re first assist,” Catherine said to Littman. She glanced around the room and focused on a pasty-faced young man standing by the door. His nametag read: Jeremy Barrows, Medical Student. “Y
ou,” she said. “You’re second assist!”

  Panic flashed in the young man’s eyes. “But—I’m only in my second year. I’m just here to—”

  “Can we get another surgical resident in here?”

  Littman shook his head. “Everyone’s spread thin. They’ve got a head injury in Trauma One and a code down the hall.”

  “Okay.” She looked back at the student. “Barrows, you’re it. Nurse, get him a gown and gloves.”

  “What do I have to do? Because I don’t really know—”

  “Look, you want to be a doctor? Then glove up!”

  He flushed bright red and turned to don a gown. The boy was scared, but in many ways Catherine preferred an anxious student like Barrows to an arrogant one. She’d seen too many patients killed by a doctor’s overconfidence.

  A voice crackled on the intercom: “Hello, Trauma Two? This is the lab. I have a hematocrit on John Doe. It’s fifteen.”

  He’s bleeding out, thought Catherine. “We need that O neg now!”

  “It’s on its way.”

  Catherine reached for a scalpel. The weight of the handle, the contour of steel, felt comfortable in her grasp. It was an extension of her own hand, her own flesh. She took a quick breath, inhaling the scent of alcohol and glove talc. Then she pressed the blade to the skin and made her incision, straight down the center of the abdomen.

  The scalpel sketched a bright bloody line on the canvas of white skin.

  “Get the suction and laparotomy pads ready,” she said. “We’ve got a belly full of blood.”

  “BP’s barely palpable at fifty.”

  “O neg and fresh frozen plasma’s here! I’m hanging it now.”

  “Someone keep an eye on the rhythm. Let me know what it’s doing,” said Catherine.

  “Sinus tach. Rate’s up to one-fifty.”

  She sliced through the skin and subcutaneous fat, ignoring the bleeding from the abdominal wall. She wasted no time with minor bleeders; the most serious hemorrhage was inside the abdomen, and it had to be stopped. A ruptured spleen or liver was the most likely source.