Too Much Blood

It occurred to me that I was about to autopsy the fourth and final member of the firm of Burke, Braithwaite, Burke, Bartlett and Brooks, Attorneys at Law, because, looking back in my records, I discovered that I had also autopsied Bill Bartlett, ten years ago. I try not to be superstitious. I am, after all, a physician, and should not be susceptible to those sorts of things, in spite of being half Irish, on my father’s side; but I had a very bad feeling about this autopsy. I had even talked to Monty, who informed me that he had already discussed the case with the hospital’s legal counsel, who said we had nothing to worry about. Mike and I had decided to handle this case as a homicide, and leave no stone unturned. Well, we didn’t do a rape kit, but other than that… First, we drew blood from the heart for possible laboratory studies. The blood flowed easily into the syringe, and we kept drawing it until we had filled every kind of tube the lab used. We collected all the urine in the Foley catheter bag. It was grossly bloody. We removed all the intravenous lines. Blood ran from the puncture sites. When we removed the endotracheal tube, the mucus was bloody. The drainage from the nasogastric tube was bloody. I had a definite feeling of déjà vu. “Mikey,” I said. “This is creeping me out.” “How’s that?” “Too much blood. It reminds me of Jay Braithwaite Burke.” The resemblance didn’t stop there. When I made my Y-shaped incision, bloody ascites fluid, under pressure within the abdomen, shot nearly to the ceiling. We hastily jumped back to avoid a bloodbath. We had to suction out several liters of it in order to see the contents of the abdomen more clearly. That was a bit of a problem, owing to extensive scarring and adhesions because of Lance’s multiple bowel resections. There were no clots at all, anywhere. Liquid blood filled the stomach, esophagus, small bowel and colon, as well as bronchi and trachea. The lungs showed hemorrhage and edema, and both chest cavities contained bloody pleural fluid. We collected gastric and small bowel contents, just in case toxicology would be needed; although we didn’t really think it would be. Normally we would have taken a chunk of liver for toxicology too, but we didn’t because Lance’s liver was almost totally replaced by grayish-white tumor nodules. The remaining uninvolved liver was dark green. The tumor originated in the head of the pancreas, and blocked not only the pancreatic duct, but also the common bile duct, causing bile to back up into the liver, which accounted for its color. We were both amazed that Lance had survived this long. The cancer certainly contributed to Lance’s death; but the actual cause of death was a coagulation disorder. Lance had bled to death, just like his partner, Jay Braithwaite Burke.