Critical by Robin Cook Page B

profanity, in the autopsy room."
    Lest she incite any further comments from Jack and subsequent retorts from Bingham, Laurie quickly headed toward Marvin and her own case. As she passed Bingham's table, she cringed for fear of being called over, but luckily Bingham had been distracted by what he called a "catastrophic mistake" on Riva's part as she dissected the neck.
    "Are you going to need anything special?" Marvin asked as Laurie came up abreast of the fifth table. As prepared as Laurie was, she generally knew in advance when special needs were required for a case.
    "A good supply of culture tubes," Laurie said as she surveyed David Jeffries's corpse. For fifty-one years of age, the man appeared to have been in good physical condition. There was no excess fat. In fact, his muscles, particularly the pectorals and quadriceps, had the definition of a much younger man.
    Laurie grimaced behind her plastic face screen. Besides the obvious infection at the surgical sites on either side of the right knee, there was a sprinkling of small pustules all over his body, which given the time would have turned into abscesses or boils. Even more striking were areas of desquamation, particularly on his pelvis, with the skin sloughing in relatively large sheets.
    "Are you looking at his hands?" Marvin asked.
    Laurie nodded.
    "What caused his skin to peel off like that?"
    "Staph makes a lot of toxins. One of them causes skin cells to separate from their neighbors."
    "Ugh," Marvin said.
    Laurie nodded again. She'd seen staph infection before, but this was the worst.
    "Anyway, to answer your question about culture tubes," Marvin said, "I got plenty."
    "Did you get a good supply of syringes as well?"
    "Yup."
    "All right, let's do it," Laurie said, as she pulled down the suspended microphone.
    "Want to check out the X-ray? I put it up just in case."
    Laurie stepped over to the view box and gazed at the film. Marvin followed and looked over her shoulder.
    "Our X-rays are mainly for foreign bodies and fractures," Laurie said. "Even so, you can certainly appreciate the pneumonia and how diffuse it is. It looks like the lungs are filled with fluid."
    "Hmmm," Marvin said. X-rays were a mystery to him. He couldn't understand how doctors could see what they did in the foggy image.
    Laurie went back to the body and completed the external examination. After making sure the endotracheal tube was where it was supposed to be in the trachea, she pulled it out. It had been placed by the doctors to ventilate him when he had begun to have trouble breathing. She cultured the bloody mucus adhered to it. Turning to the multiple IV lines, she made sure they were also properly placed and, after doing so, pulled them out and cultured them as well. Medical examiners insisted such tubes be left in place to be sure that they played no role in the patient's death. She also cultured the pus issuing from the surgical site.
    Once the external exam had been finished and dictated, Laurie began the internal with the standard Y-shaped incision starting at both shoulders, meeting at the midline, and then extending down to the pubis. She worked quietly, shunning the usual banter she normally exchanged with Marvin, who was an eager learner.
    For a time, Marvin stayed quiet as well, correctly sensing Laurie's awe at the virulence of the microbe that had played such havoc throughout David Jeffries's body. It wasn't until Laurie lifted out the heart and lungs and put them in the pan he was holding that he broke the silence. "Shit, man," he commented. "This baby weighs a ton."
    "I noticed," Laurie said. "I think we'll find both lungs full of fluid." After she removed the lungs and weighed each separately, she made multiple slices into them. Like fully soaked sponges, a mixture of edema fluid, blood, necrotic tissue, and pus emerged.
    "Ye gods!" Marvin said. "That's ugly."
    "Have you heard of the term flesh-eating bacteria?"
    "Yeah, but I thought people only got that in their