Read Online Fatal Care by Leonard Goldberg - Free Book Online Page B

enlargement or scarring. The anterior surface of the heart glistened in the light. It weighed four hundred grams.
    “The heart is usually bigger in someone his age,” Joanna commented. “Particularly when there’s a history of cardiac disease.”
    “Don’t forget he had his coronary arteries cleaned out,” Lori said. “They’re like new.”
    “But this is the heart of an athlete,” Joanna went on. “You said he was a jogger. Right?”
    Lori nodded. “He ran a couple of miles on an almost daily basis, and he was an avid tennis player, too.”
    Joanna cut into the wall of the left ventricle and studied the cardiac musculature. “This heart looks like it belongs to someone twenty-five years old.”
    “A new set of coronary arteries can do wonders,” Lori said.
    “Maybe,” Joanna said, unconvinced. She had done autopsies on patients who had had coronary bypass surgery and died of other causes. Their grafts were still open and had provided excellent coronary blood flow. But their hearts never looked this good.
    “Is there any evidence of myocardial infarction?” Murdock asked worriedly.
    “Not so far.” Joanna sliced open a major coronary artery and studied its interior. There were no fatty deposits or occlusions. “The left main coronary looks very clean.”
    Murdock groaned to himself. No heart attack, no new institute. “Perhaps one of the other coronaries is blocked.”
    “Perhaps,” Joanna said. But the other coronary arteries appeared to be wide open with not even a hint of blockage. There was no evidence for a myocardial infarction. Joanna began thinking about noncardiac causes of sudden death in a middle-aged man. An acute cerebral hemorrhage topped the list. “Simon, we may have to examine Oliver Rhodes’s brain.”
    “The Rhodes family wants to avoid that,” Murdock said. “At the funeral service his body will be viewed.”
    Joanna shrugged. “We may have no choice but to open his skull.”
    She went back to the heart and split it apart, exposing the interventricular septum and the endocardial wall. There were postmortem blood clots blocking her view, so she swept them away.
    Then she saw it. A large pinkish red mass growing out of the septum. She looked over at Simon Murdock. “Oliver Rhodes did not have a myocardial infarction. But he did have a cardiac-related death.”
    Murdock’s eyes brightened. “Are you
sure
?”
    “Take a look at the superior aspect of the interventricular septum.”
    Joanna spread the heart open again and pointed at the large mass that involved the upper septum and extended down into the endocardial wall. “It’s a tumor.”
    Murdock stared at her quizzically. “Of the
heart
?”
    Joanna nodded. “It’s rare, but it happens.”
    Murdock snapped on a pair of latex gloves and felt the firm, fixed mass. “How rare is it?”
    “I’ve been here over ten years, and I’ve seen only one case.”
    Lori leaned in for a closer view. “How do you know it’s not a metastatic lesion? Maybe it’s a metastasis from that pulmonary nodule.”
    “That’s a possibility,” Joanna conceded. “But I think it’s unlikely for several reasons. First, metastatic lesions to the endocardium are rare, even rarer than primary cardiac malignancies. Secondly, metastases from the lung to the heart are usually the result of direct extension and almost always involve the outer pericardium, not the endocardium. That having been said, the only way to really tell if it’s a primary tumor of the heart is by examining it under a microscope.”
    Lori nodded to herself, thinking aloud. “If it’s a primary heart tumor, it’ll be a sarcoma. If it’s a metastasis from the lung, it’ll be a carcinoma.”
    “Right.”
    Murdock asked, “Can you tell the difference between the two on frozen section?”
    “I would think so,” Joanna answered.
    Murdock glanced up impatiently at the wall clock. It was eleven. “Where the hell is the on-call pathologist?”
    “He should be here in a