section, opening it up, continuing to dictate into the hanging microphone above his head. ‘The wall is friable and tore on minimal disruption. There are longitudinal ulcers near the caecum.’ He extended the cut. ‘And in sections of the large bowel.’
Schiller reached over to see. ‘Could she have had Crohn’s?’ He added, ‘When we were fourteen, my twin brother got sick and lost all this weight. They diagnosed it on colonoscopy. He used to pass blood.’
‘Crohn’s is a possibility, but it’s too early to reach a conclusion.’
An inflammatory bowel disease might explain what they were seeing, but Anya was drawn to the appearance of the kidneys.
Clive pulled a stretch of bowel to the side and exposed them. Like the bowel, both were congested and inflamed. He asked for a needle and syringe, which the technician prepared. Inserting it into the tiny bladder, he pulled back on the plastic syringe. He repeated the process. The syringe remained empty. ‘Looks like she was anuric.’
‘Anuric?’ The detective took notes on a small pad.
‘She wasn’t producing any urine,’ Anya answered. ‘You’d expect the bladder to have something in it, even if she had recently voided.’
The phone in the centre rang. The technician answered and handed it to Anya.
‘Ken Kuah, Professor of Haematology. I’m told this is an urgent police investigation so I had a look at the blood films myself.’
Dr Arneil asked Anya to place the handset on speakerphone and open the email on the desk laptop. Anya clicked on the message sent by Kuah. Multiple images downloaded. Anya enlarged the first one. ‘We’re looking at the first slide now. Full blood count showed leucocytosis, white cell count was forty-one. Haemoglobin’s down but haematocrit’s up. There’s a marked thrombocytopenia. As you can see, there are significant numbers of schistocytes.’
‘What are they from?’ Schiller was understandably impatient to know what it all meant.
‘The Greeks, of course,’ Clive answered. ‘ Schistos – divided, and kytos – cell.’
To save time, Anya pointed to the screen. ‘Can you see how these cells are irregular and look like broken pieces?’
‘Yeah, compared to the red, round ones.’ Schiller was concerned with their relevance to the investigation. ‘Do they happen with physical trauma? Maybe as a result of what that Heyes did to the nasal area?’
‘They are damaged, but at a microscopic level, when they pass thrombi, or clots,’ Dr Kuah commented. ‘We didn’t receive a clinical history, just a date of birth. Did the child have an artificial heart valve?’
‘No,’ Clive said. ‘I’m looking at a friable, ulcerated large intestine.’
‘Sorry,’ the detective interrupted, ‘you’re talking about clots? If the blood was full of clots, doesn’t that mean she won’t bleed much? I mean, someone’s blood was all over that bathroom floor and if it isn’t hers . . .’
Anya clarified, ‘Microscopic clots occur in vessels and organs, using up things called thrombocytes or platelets. They’re what stop you bleeding to death if you have a simple nose bleed or a cut.’
‘Okay,’ Schiller reasoned, ‘so once they are all used up . . .’
‘Inflammation leads to leaking blood vessels. Without platelets, bleeding getsout of control. It means,’ Anya deduced, ‘the blood on the floor in the bathroom could have come from Emily’s bowel.’
Schiller asked quietly, ‘Just so we’re all clear. Did outside interference, like a sexual assault, cause the bowel inside to bleed?’
‘Detective,’ Clive interrupted, ‘in this case the rectum was doing what it was designed for. It is an exit, not an entrance. There is nothing to suggest sexual assault in this instance.’
Anya felt relieved for Emily. She clicked the next image on the computer. ‘I’m looking at the electrolytes. Raised serum creatinine, lactic dehydrogenase, low sodium, elevated potassium. Kidney failure and severe
Schiller reached over to see. ‘Could she have had Crohn’s?’ He added, ‘When we were fourteen, my twin brother got sick and lost all this weight. They diagnosed it on colonoscopy. He used to pass blood.’
‘Crohn’s is a possibility, but it’s too early to reach a conclusion.’
An inflammatory bowel disease might explain what they were seeing, but Anya was drawn to the appearance of the kidneys.
Clive pulled a stretch of bowel to the side and exposed them. Like the bowel, both were congested and inflamed. He asked for a needle and syringe, which the technician prepared. Inserting it into the tiny bladder, he pulled back on the plastic syringe. He repeated the process. The syringe remained empty. ‘Looks like she was anuric.’
‘Anuric?’ The detective took notes on a small pad.
‘She wasn’t producing any urine,’ Anya answered. ‘You’d expect the bladder to have something in it, even if she had recently voided.’
The phone in the centre rang. The technician answered and handed it to Anya.
‘Ken Kuah, Professor of Haematology. I’m told this is an urgent police investigation so I had a look at the blood films myself.’
Dr Arneil asked Anya to place the handset on speakerphone and open the email on the desk laptop. Anya clicked on the message sent by Kuah. Multiple images downloaded. Anya enlarged the first one. ‘We’re looking at the first slide now. Full blood count showed leucocytosis, white cell count was forty-one. Haemoglobin’s down but haematocrit’s up. There’s a marked thrombocytopenia. As you can see, there are significant numbers of schistocytes.’
‘What are they from?’ Schiller was understandably impatient to know what it all meant.
‘The Greeks, of course,’ Clive answered. ‘ Schistos – divided, and kytos – cell.’
To save time, Anya pointed to the screen. ‘Can you see how these cells are irregular and look like broken pieces?’
‘Yeah, compared to the red, round ones.’ Schiller was concerned with their relevance to the investigation. ‘Do they happen with physical trauma? Maybe as a result of what that Heyes did to the nasal area?’
‘They are damaged, but at a microscopic level, when they pass thrombi, or clots,’ Dr Kuah commented. ‘We didn’t receive a clinical history, just a date of birth. Did the child have an artificial heart valve?’
‘No,’ Clive said. ‘I’m looking at a friable, ulcerated large intestine.’
‘Sorry,’ the detective interrupted, ‘you’re talking about clots? If the blood was full of clots, doesn’t that mean she won’t bleed much? I mean, someone’s blood was all over that bathroom floor and if it isn’t hers . . .’
Anya clarified, ‘Microscopic clots occur in vessels and organs, using up things called thrombocytes or platelets. They’re what stop you bleeding to death if you have a simple nose bleed or a cut.’
‘Okay,’ Schiller reasoned, ‘so once they are all used up . . .’
‘Inflammation leads to leaking blood vessels. Without platelets, bleeding getsout of control. It means,’ Anya deduced, ‘the blood on the floor in the bathroom could have come from Emily’s bowel.’
Schiller asked quietly, ‘Just so we’re all clear. Did outside interference, like a sexual assault, cause the bowel inside to bleed?’
‘Detective,’ Clive interrupted, ‘in this case the rectum was doing what it was designed for. It is an exit, not an entrance. There is nothing to suggest sexual assault in this instance.’
Anya felt relieved for Emily. She clicked the next image on the computer. ‘I’m looking at the electrolytes. Raised serum creatinine, lactic dehydrogenase, low sodium, elevated potassium. Kidney failure and severe
Similar Books
