Read Online The Silent Sleep of the Dying (Eisenmenger-Flemming Forensic Mysteries) by Keith McCarthy - Free Book Online Page A
Authors: Keith McCarthy
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malignancy. When he had opened the intestines — all ten metres of them — he had expected to find only surface involvement by tumour, spread from outside, but he had instead found the lining of both the large and small intestines carpeted with polypoid growths large and small. Nestling amongst which were no less than six cancers, two in the small intestine and four in the large.
The stomach contained three tumours and the lumen of the gullet was obliterated by a solid mass of cancerous tissue; these lesions rested on a curious, velvety-red surface which was quite unlike the usual appearance. Hartmann suspected that it represented some form of "field change," that all of the stomach and oesophageal lining was turning malignant.
Even the larynx contained scattered nodules that were almost certainly cancerous. The spleen, normally weighing between one and two hundred grams, was huge and clocked in at nearly two kilograms; its cut surface was speckled with white spots, some nearly a centimetre in diameter.
Hartmann had gone back to the body cavity and began to feel the dead, firm muscles and bones. It had not been long before he had felt a firm lump in the musculature of the right calf and, uncaring of the danger of a hosepipe down his trousers, he had incised the skin to reveal yet another tumour. In a similar fashion he had found two more muscle tumours and then gone to find that the right femur, right humerus, left side of the pelvis and left shoulder blade were all focally expanded; he had chipped away the surface bone to reveal yet more tumours.
The bone marrow, exposed by stripping off the front of the spinal column was pale grey and softly fluctuant; Hartmann could find no surprise within himself when he discovered this. He looked in the mouth and found extensive ulceration and Hartmann knew that its cause wasn't ill-fitting denturework.
"This is impossible." Belinda's remark was understandable but neither helpful nor, by definition, accurate. Hartmann had been afraid that she would show him up for a fool, but it was clear that this case was showing them both the limits of their wisdom. He knew that he was hopelessly lost but he had enough experience and enough innate wisdom to try to adopt a reasonable coping strategy.
First, run through the facts in your mind. Lay them out before you try to connect them. "Look," he said to Belinda. "Let's just start at the beginning. She was a girl in her early twenties. It's improbable but not impossible that she might develop cancer at that age, but the range of tumours she's likely to develop is limited. I wouldn't be surprised to see a thyroid tumour, or even some types of gynaecological malignancy. Other possibilities include lymphoma or leukaemia which may well affect this age group, bone cancers and a variety of soft tissue tumours."
"And brain tumours."
"And brain tumours. And, it would appear from macroscopic examination, we actually may well have those tumour types here."
"But she should have only one of them."
"And that's the problem. She hasn't just got one of them, or two of them. She's got all of them and more; tumours she shouldn't have developed for another fifty years — lung carcinoma, colorectal carcinoma, what looks like a liposarcoma."
Belinda was frowning intensely. "You don't suppose," she said tentatively, "that it's just one of them that's spread all over the place?" she asked.
There was a pause while Hartmann thought again about that possibility but, if he wasn't the best pathologist in the Royal College, he was good enough to know that wasn't the reason. He indicated the lining of the intestine; it was covered in a carpet of red growths like tropical sea anenomes. "Look at those adenomatous polyps. They're premalignant, suggesting she has a primary colonic carcinoma. Yet if you look in the breasts, both of them contain not only invasive tumours but also evidence of cancers that are still in-situ, yet to spread."
"Suggesting that the breast
The stomach contained three tumours and the lumen of the gullet was obliterated by a solid mass of cancerous tissue; these lesions rested on a curious, velvety-red surface which was quite unlike the usual appearance. Hartmann suspected that it represented some form of "field change," that all of the stomach and oesophageal lining was turning malignant.
Even the larynx contained scattered nodules that were almost certainly cancerous. The spleen, normally weighing between one and two hundred grams, was huge and clocked in at nearly two kilograms; its cut surface was speckled with white spots, some nearly a centimetre in diameter.
Hartmann had gone back to the body cavity and began to feel the dead, firm muscles and bones. It had not been long before he had felt a firm lump in the musculature of the right calf and, uncaring of the danger of a hosepipe down his trousers, he had incised the skin to reveal yet another tumour. In a similar fashion he had found two more muscle tumours and then gone to find that the right femur, right humerus, left side of the pelvis and left shoulder blade were all focally expanded; he had chipped away the surface bone to reveal yet more tumours.
The bone marrow, exposed by stripping off the front of the spinal column was pale grey and softly fluctuant; Hartmann could find no surprise within himself when he discovered this. He looked in the mouth and found extensive ulceration and Hartmann knew that its cause wasn't ill-fitting denturework.
"This is impossible." Belinda's remark was understandable but neither helpful nor, by definition, accurate. Hartmann had been afraid that she would show him up for a fool, but it was clear that this case was showing them both the limits of their wisdom. He knew that he was hopelessly lost but he had enough experience and enough innate wisdom to try to adopt a reasonable coping strategy.
First, run through the facts in your mind. Lay them out before you try to connect them. "Look," he said to Belinda. "Let's just start at the beginning. She was a girl in her early twenties. It's improbable but not impossible that she might develop cancer at that age, but the range of tumours she's likely to develop is limited. I wouldn't be surprised to see a thyroid tumour, or even some types of gynaecological malignancy. Other possibilities include lymphoma or leukaemia which may well affect this age group, bone cancers and a variety of soft tissue tumours."
"And brain tumours."
"And brain tumours. And, it would appear from macroscopic examination, we actually may well have those tumour types here."
"But she should have only one of them."
"And that's the problem. She hasn't just got one of them, or two of them. She's got all of them and more; tumours she shouldn't have developed for another fifty years — lung carcinoma, colorectal carcinoma, what looks like a liposarcoma."
Belinda was frowning intensely. "You don't suppose," she said tentatively, "that it's just one of them that's spread all over the place?" she asked.
There was a pause while Hartmann thought again about that possibility but, if he wasn't the best pathologist in the Royal College, he was good enough to know that wasn't the reason. He indicated the lining of the intestine; it was covered in a carpet of red growths like tropical sea anenomes. "Look at those adenomatous polyps. They're premalignant, suggesting she has a primary colonic carcinoma. Yet if you look in the breasts, both of them contain not only invasive tumours but also evidence of cancers that are still in-situ, yet to spread."
"Suggesting that the breast
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