The Sinner: A Rizzoli & Isles Novel

basement.
    The first thing she noticed, as she stepped inside the dim office of Dr. Julie Cawley, were the human skulls—at least a dozen of them, lining the shelves. A lone window, set high in the wall, was half covered by snow, and the light that managed to seep through shone down directly on Dr. Cawley’s head. She was a handsome woman, with upswept gray hair that looked pewter in the wintry light.
    They shook hands, an oddly masculine greeting between two women.
    “Thank you for seeing me,” said Maura.
    “I’m rather looking forward to what you have to show me.” Dr. Cawley turned on a lamp. In its yellowish glow, the room suddenly seemed warmer. Cosier. “I like to work in the dark,” she said, indicating the glow of the laptop on her desk. “It keeps me focused. But is hard on these middle-aged eyes.”
    Maura opened her briefcase and removed a folder of digital prints. “These are the photos I took of the deceased. I’m afraid they’re not very pleasant to look at.”
    Dr. Cawley opened the folder and paused, staring at the photo of Rat Lady’s mutilated face. “It’s been a while since I’ve attended an autopsy. I certainly never enjoyed it.” She sat down behind the desk and took a deep breath. “Bones seem so much cleaner. Somehow less personal. It’s the sight of flesh that turns the stomach.”
    “I also brought her X rays, if you’d rather look at those first.”
    “No, I do need to look at these. I need to see the skin.” Slowly she flipped to the next photo. Stopped and stared in horror. “Dear god,” she murmured. “What happened to the hands?”
    “They were removed.”
    Cawley shot her a bewildered look. “By whom?”
    “The killer, we assume. Both hands were amputated. So were parts of the feet.”
    “The face, the hands, the feet—those are the first things I’d look at to make this diagnosis.”
    “Which could be the reason why he removed them. But there are other photos in there that might help you. The skin lesions.”
    Cawley turned to the next set of images. “Yes,” she murmured, as she slowly flipped through them. “This certainly could be . . .”
    Maura’s gaze lifted to the row of skulls on the shelf, and she wondered how Cawley could work in this office, with all those empty eye sockets staring down at her. She thought of her own office, with its potted plants and floral paintings—nothing on the walls to remind her of death.
    But Cawley had chosen to surround herself with the evidence of her own mortality. A professor of medical history, she was a physician as well as an historian, a woman who could read a lifetime’s worth of miseries etched in the bones of the dead. She could look at the skulls on her shelf and see, in each, a personal history of pain. An old fracture or an impacted wisdom tooth or a jawbone infiltrated by tumor. Long after the flesh melts away, the bones still tell their stories. And judging by the many photos of Dr. Cawley taken at archaeological dig sites around the world, she had been mining these stories for decades.
    Cawley looked up from a photo of one of the skin lesions. “Some of these do bear a resemblance to psoriasis. I can see why it was one of the diagnoses you considered. These could also be leukemic infiltrates. But we’re talking about a great masquerader. It can look like many different things. I assume you did skin biopsies?”
    “Yes, including stains for acid-fast bacilli.”
    “And?”
    “I saw none.”
    Cawley shrugged. “She may have received treatment. In which case there’d be no bacilli still present on biopsy.”
    “That’s why I came to you. Without active disease, without bacilli to identify, I’m at a loss as to how to make this diagnosis.”
    “Let me see the X rays.”
    Maura handed her the large envelope of films. Dr. Cawley carried them to a viewing box mounted on her wall. In that office cluttered with artifacts from the past—skulls and old books and several decades’ worth of photos—the light box stood out as a starkly modern feature. Cawley rifled through the X rays and finally slid one under the mounting clips.
    It was a skull film, viewed face-on. Beneath the mutilated soft tissues, the bony structures of the face remained intact, glowing like a death’s head against the black background. Cawley studied the film for a moment, then pulled it down and slid on a lateral view, taken of the skull’s profile.
    “Ah. Here we go,” she murmured.
    “What?”
    “See here?