Terry carries his black bag over to my station and sets it on the surgical cart. He gets out a dental mirror and goes inside the dead man’s mouth. We work in silence, the weight of what has just occurred pressing down hard. I reach for a bigger knife and cut sections of organs, slicing through the heart. Tue coronary arteries are open and clear, the left ventricle one centimeter wide, the valves normal. Other than a few fatty streaks in the aorta, the heart and vessels are healthy. The only thing wrong with it is the obvious: It quit. For some reason, this man’s heart stopped. I find no explanation anywhere I look.
“Like I said, this one’s easy,” Terry says as he makes notes on a chart. His voice is nervous. He wishes he had never answered the phone.
“He’s our guy?” I ask him.
“Sure is.”
The carotid arteries lie like rails in the neck. Between them are the tongue and neck muscles, which I flip down and peel away so I can examine them closely on the cutting board. There are no hemorrhages in deep tissue. The tiny, fragile U-shaped hyoid bone is intact. He wasn’t strangled. When I reflect back his scalp, I find no contusions or fractures hiding underneath. I plug a Stryker saw into the overhead cord reel and realize I need more than one hand. Terry helps me steady the head as I push the whining, vibrating semicircular blade through the Skull. Hot, bony dust drifts on the air, and the skullcap lifts off with a soft sucking sound, revealing the convoluted horizon of the brain. On gross examination, there is nothing wrong with it. Slices gleam like creamy agate with gray ruffled edges as I rinse them on the cutting board. I will save the brain and heart for further special studies, fixing them in formalin and sending them to the Medical College of Virginia.
My diagnosis this morning is one of exclusion. Having found no obvious, pathological cause of death, I am left with one that is based on whispers. Tiny hemorrhages on heart and lungs and burns and abrasions from bondage suggest Mitch Barbosa died from stress-induced arrhythmia. I also postulate that at some point he was holding his breath or his airway was obstructedor for some reason his breathing was compromised to the extent that he partially asphyxiated. Perhaps the gag, which would have gotten wet from saliva, is to blame. Whatever the truth, I am getting a picture that is simple and ghastly and calls for demonstration. Terry and Marino are handy.
First I cut off several lengths of the thick white twine that we routinely use to suture up Y-incisions. I tell Marino to push up the sleeves of his surgical gown and hold out his hands. I tie one segment of twine around one wrist and a second strand around the other, not too tight, but snug. I instruct him to hold his arms up in the air and direct Terry to grab the loose ends of twine and pull up. Terry is tall enough to do this without a chair or footstool. The bindings immediately dig into the underside of Marino’s wrists and are angled up toward the knots. We try this in different positions, with variations of the arms close together and spread wide crucifixion-style. Of course, Marino’s feet remain squarely on the floor. In no instance is he hanging or even dangling.
“The weight of a body on outstretched arms interferes with exhalation,” I explain. “You can inhale but it’s difficult exhaling because the intercostal muscles are compromised. Over a period of time, this would lead to asphyxia. You add that to the shock of pain from torture, you add fear and panic, and you could certainly suffer from an arrhythmia.”
“What about the nosebleed?” Marino holds out his wrists and I examine the indentations the twine has left in his skin. They are angled up similarly to those on the dead man.
“Increased intracranial pressure,” I say. “In a breath-holding situation, you can get nosebleeds. In the absence of injury, that’s a good guess.”
“My question is whether someone meant to kill him?” Terry poses.