Plague

Chapter 7 Day 1, 10:45 PM

Chapter 7
Day 1
10:45 PM

They walked to the elevator in silence, pushing the gurney with the dead boy’s body, lost in their own thoughts. As they rode the elevator to the basement, Jacob was silent. He tried to understand the similarities between the Mexican boy and Kenny Jackson. He could come to no conclusion as they reached the double doors leading to the Pathology Laboratory and pushed through them. Joan didn’t say anything. She just helped push the gurney and watched Jacob’s face.
Stephan was obviously engrossed with something on the table. He acknowledged their presence without turning around and pointed excitedly to the mass of gelatinous tissue on a tray in front of him.
“The results of the autopsy are pretty conclusive in some ways,” he told them. “The boy died from a massive intracranial bleed. There is nothing wrong with any other major organs, at least on gross examination. What fascinates me is the lack of brain tissue in the cerebellum and the posterior parts of the cerebral hemispheres.
“If you look over here, and here, you can see chunks of brain missing from the middle of the cerebellum in the back of the brain.”
His fingers seemed to point to things quickly, then move and point to something else. It didn’t even seem like Stephan was looking at what he was pointing to.
“It almost looks like a cored apple. I don’t have to be a neuropathologist to see that. Another interesting thing is that the brain tissue loss is in a very erratic pattern. This is not tissue destruction from a stroke or cancer. I’ll bet there’s little or no tissue reaction surrounding the areas of tissue loss, like you’d see from a stroke or other typical physiological problem; of course I’ll check for that. This is really weird.”
He took a probe and pushed it easily through areas of the boy’s brain that should have had neurons, or nerve cells filling them.
“It almost looks like something scooped out the brain starting here,” he gestured with his metal probe, “and then in a continuous curving line through both sides of the brain and then down to the base of the brain. There, the major blood vessels leading from the base of the brain, the Circle of Willis, have been severed on the left side. This explains why the kid died.
“The bad news is that I have no idea how this happened. The remaining brain looks normal. I can’t find anything in the tract that seems to have been plowed through his brain to tell me what caused it to happen.
“It’s really a fascinating problem,” he finished.
“Did you find anything else, any unusual marks on the body?” Jacob asked him. “I already looked at the head and neck and didn’t find anything.”
Stephan cast Jacob a haughty look and continued to talk in his pontificating style.
“There were numerous abrasions and laceration over the extremities and on the left side of the torso. There was also a two by three millimeter punctate lesion on the left side of the head, behind and just under the boy’s left ear.”
He smiled smugly and looked very self-satisfied.
“I’m sure there was nothing there when I looked at the body before. I’d like to see that,” Jacob said.
“Certainly, Jacob. Take a look over here.”
Stephan lifted the cadaver’s head and, turning it so they could all see the left side, pointed triumphantly to a punctate, or round puncture wound, under and behind the ear.
Jacob stared at the damned thing and felt foolish. He didn’t understand how he could have missed it. He bent closer to look at the wound.
“Stephan, there is no blood coming from the puncture. If you look closely at the skin, it seems to turn out, rather than into the wound. Could you have accidentally done this during the autopsy?”
“Jacob, you know better than that. The blood was probably wiped off when Tom and I moved the boy’s body to the autopsy table. I wouldn’t worry about the skin, either. As a pathologist, I’ve seen a lot of wounds that look like that.”
Jacob picked up the probe Stephan had been using and gingerly placed it at the mouth of the small opening on the boy’s neck. He pushed very gently, holding his breath. Stephan and Joan both leaned closer as the tip of the probe moved easily into the hole. It continued to move easily until it stuck straight out and into the empty interior of the skull. It had angled slightly up to the ear and out through the deep part of the ear, the auditory meatus. And it then went into the area where the brain used to sit.
Stephan took the probe from Jacob and gently removed it from the skull and then reinserted it again.
“Did you force this?” he asked Jacob.
“No. It just slid right in on a smooth tract.”
Stephan continued to move the probe back and forth and squinted into the inside of the skull.
“How would you describe the area surrounding the missing brain tissue,” Jacob asked him.
“I told you, I don’t think there is any tissue reaction surrounding the lesion, like you’d see if there was something going on for a while before the boy’s death. You can see for yourself where I cut through the site. The only other thing to say is that the sides of the tract were rather rough, like the tissue had been scooped out.”
Joan mumbled something unintelligible, but it was ignored.
“Stephan,” Jacob said, “I’d like to see what the other boy’s brain looks like. Let’s do it now!”
“Jacob, you can’t just do an autopsy like that,” Joan said. “I haven’t even told the family that their son is dead.”
“Joan, it has to be done now! Why don’t you go tell them and get permission for the autopsy. I’m sure you won’t have any problems if you tell them that the disease may be contagious and legally we just have to do it. Besides, we have to find out what’s going on here!”
Joan continued to protest as Jacob practically pushed her out the door. Stephan was already positioning the Jackson boy’s body on an autopsy table, placing a wooden block under the neck to facilitate his approach to the brain.
Without any wasted motion Stephan cut smoothly through the skin of the head and peeled it back over the dead boy’s face. Then he used an electric saw to take off the top of the boy’s skull.
As the bone was lifted off, they saw a lot of blood that seemed to spill from inside the skull, over the head and onto the table.
Stephan grunted and began to clean off the blood to clear the way for him to take out the brain. He used a scalpel to slice through the optic nerves and the membranes and blood vessels that held the brain in place in the skull. Within minutes, the brain was placed onto an examining tray and the remains of the boy’s head were covered up.
“A quick and dirty job, Jacob. I had to sacrifice a lot of the smaller nerves and blood vessels.”
Stephan looked over the mass of brain tissue before him.
“The most obvious pathology is the loss of brain tissue in the back of the brain, the cerebellum and the brain stem, very much like the Mexican boy.”
He was silent for several minutes as he cut the brain into sections and probed the areas in the back of the brain. Finally, he stripped off his latex gloves and sat down in a chair, looking reflectively at the dissected brain.
Without looking at Jacob, he said, “Actually, both brains have had the same type of insult. Something got in there, into the brain, and scooped out large parts of the back of the brain, also causing a lot of damage to the bottom of the brain, the brainstem, as well as posterior parts of the cerebral cortex, especially the back part of the brain, the occipital lobes. The boy must have been almost blind before he died. His death was caused by a rupture of both posterior cerebral arteries. There was also a laceration in the blood vessel feeding the brain from the spinal cord area, the basilar artery.
“In general, there was more tissue missing in the second boy’s brain. There weren’t as many tracts, just large hollowed out areas. There were several short tracts going from one hollow area to another. The lesions had to be fresh because there was no tissue reaction to its destruction.
“The sides of the areas missing brain tissue are rough, like in the first brain.
“To be honest, I don’t have the foggiest idea of what is going on here. There is nothing I’ve ever heard of that can do that to the brain of a living person. I just don’t know what to think.”
“Did you find any wounds on the boy’s neck?” Jacob asked.
Rather than answer him, Stephan got up and went over to the boy’s body and began examining the neck and head. Jacob went over to the other side of the head and started looking.
There were no lacerations or puncture marks and no signs of head trauma. Jacob was about to give up when he noticed some blood in the ear. Not much, but it was something.
“Stephan, take a look at this. Give me the probe, too,” Jacob said.
There was no observable lesion on the neck. There was evidence of a couple of drops of blood in the external ear canal. Jacob took the probe and slid it smoothly though the meatus, the external and internal canals of the ear, and then out into the empty skull. He tried the same maneuver on the other side of the head, but the probe was stuck before it could pass through the tympanic membrane of the ear.
The two physicians decided that the rest of the autopsy could wait until the morning. They put the brains in formalin and the bodies in the freezer room.
One thing was obvious to both of them. They were dealing with something that was new to them and possibly new to medicine as they knew it. They didn’t know what it was, how it worked or anything else that would give them an idea as to what was happening.
Then again, exactly what was happening?
Two children dead within hours of each other, with similar pathology. Parts of their brains were missing. Something odd was seen on the CAT scan of the first child’s brain.
Either entrance and/or exit passages were found in both children’s heads.
Something has gotten into their brains, either through their ears or another way, and it left through the ears. But, it went into the brains of the two children.
And seemed to have eaten parts of their brains. Nothing they knew of could do that.
So, what was it?