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Black Lamb

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Till death us do…

The parts cannot add up to the whole.

November 1st, 2009

BY LANE BROWNING

The scalp and subgaleal tissues appear normal. The calvarium is typical in thickness. There is very little fluid in the chest cavities.

She was an internationally known author and educator. She was indefatigable, wise, a beacon for thousands. My friend, my familiar.

doctorholdingheart.pngThe heart weighs 370 grams and has the typical configuration. The epicardium is smooth and glistening. The coronary arteries show a right dominant pattern. The atrium are (sic) normal.

We emailed every day, sometimes many many many times a day. We collaborated on two books and a series of educational CDs. We weathered rotating life traumas via the Internet tether. She called me her “sister by choice,” and she was, professionally, a savior to my son.

But until she died I didn’t know that her epicardium glistened.

The eyes are light brown. The pupils are symmetrical. The earlobes are each pierced once.

I paid fifty cents a page for a copy of the medical examiner’s report. They mailed it, no charge. I didn’t have to give my name or cite any reason. They take cash, VISA, even personal check (no PayPal?). They sent me two copies and a bonus: the police report. Police report? I had no idea there was one.
I also didn’t know she had gallstones, one of which was obstructing the bile duct. That must have hurt. She had a prescription for Oxycodone, the report tells me.

The cerebrospinal fluid is clear. The four valves of the heart are thin and pliable without vegetations and have the expected circumferences. The nails of the feet are painted ruby red.

Toenail polish. In February.

“The decedent was dead on scene,” notes the Time of Death Report. That document says her temperature was 103 degrees. Wince. She was sick those last couple of days, exhausted after a trip to London, a four-hour meeting with a client, and a clinical training session at a Montessori school. She was worn out, a rash on her back, tremors in her hands, her gait unsteady.
She worked a lot. A lot. Her work and her life were one and the same, and nearly all of it was pro bono.

The right lung weighs 450 grams; the left lung weighs 430 grams. The lungs are extremely well-aerated. The bronchi are normal.

If she were hospitalized and comatose, I’d know nothing. All privileged information. But as “decedent” she is mine. She is anyone’s. Everything about her. Her height (5'7″? I would have guessed five feet and change). The hue of her skeletal muscles (red). The dimensions of the uterine polyps percolating away in there. Her weight. The color of the body bag.

Yes, even that.

Jewish tradition forbids autopsies, but the provisions of the Georgia Death Investigation Act overrode her son’s objection. Because of laws governing Atlanta, I have these pieces of paper. Her son, whose PhD thesis explored human genomic DNA sequencing, would need no dictionary for “splenic parenchyma” or “chordae tendineae.”

He would be surprised, though, to see me standing in my kitchen reading about his mother’s coccyx and kneecaps. He and I never met.

But, Matt, she’s gone, and I wanted to know why.

Gone yes, but vibrant here in black and white and corpuscle and cell. The medical examiner never heard that distinctive high-pitched voice or saw the gentle placements of those small healing hands. But he did see her hair — he called it “well cared for.” Yes yes, but I would have said, also, how beautiful it was, and how thick and lush and clean as perfect Arctic snow. If an epicardium can glisten, can’t hair shimmer?

The why, as stated, was “atherosclerotic coronary artery disease.” The document cites “…an up to 50% stenotic lesion” in the mid portion of the right coronary artery and “an up to 50% stenotic lesion” in the “distal portion of the left anterior descending coronary artery.” How quaint, the imprecision of “up to 50%.” So no chance of 51%. That means the passageways were at least halfway unblocked.

Not enough, apparently, because “severe coronary atherosclerosis” was the lurking assassin.

I wouldn’t have been surprised if they’d found four hearts in there. The generous pulse of that organ beats, now, within thousands of unusual people whose struggles and confusion she understood and embraced. Her schedule was mapped out months ahead, but she lived, always, within the immediate minute. She knew the presence of the present.

The liver weighs 2000 grams. The liver parenchyma is red-brown and firm without increase in fibrosis, cirrhosis, or cysts. The gallbladder is markedly enlarged to 4 or 5 times its normal size.

There was a copper ring around one wrist, another around one ankle. She never took those off.

The spleen weighs 280 grams. No follicular pattern is noted. The lymph nodes are the usual size and shape. The bronchi are normal. The hyoid bone and laryngeal cartilages are free of injury. The tongue is normal. The duodenum is normal. There is no muscle wasting.

Although her life was a tsunami of health challenges, she left a carcass with a lot of “typical” and “normal” features. The coroner says “the head is normal in size and shape.” He knew nothing about the harrowing jaw and cranial surgeries, relentless pain and persistent misalignment. How fascinating she would find all this! How amusing, how prosaic, even how lyrical. She laughed readily, my friend did. She married clinical maturity with childlike goofiness, pragmatism with empathy. She was steely but squishy.

I knew, of course, that she was just water, carbon, calcium, pigment. I knew it was only epidermis over bone, electrical impulses manifesting as responses. I knew we all begin as small clumps of undifferentiated cells. She knew too; her work was about the trigeminal and optic nerves, the amygdala, reflexes, vestibular structures in the ear. She knew, and I knew, it was all transitory and very capricious.

The essential person, my friend, is gone. And now anyone with a dollar or two can read this:

There is a small amount of facial hair under the chin that has been shaved.

We are memories, newspaper text, start-end dates, and — sometimes — pre-mortem vanity co-opted by a stranger.

I miss her. •

Posted by: The Editors
Category: Browning | Link to this Entry

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