The Surgeon: A Rizzoli & Isles Novel: With Bonus Content

Tierney. “He left the bladder and bowel intact.”
    “What’s this thing I’m feeling here? This hard little knot, on the left side,” she said.
    “It’s suture. He used it to tie off blood vessels.”
    Rizzoli looked up, startled. “This is a
surgical
knot?”
    “Two-oh plain catgut,” ventured Moore, looking at Tierney for confirmation.
    Tierney nodded. “The same suture we found in Diana Sterling.”
    “Two-oh catgut?” asked Frost in a weak voice. He had retreated from the table and now stood in a corner of the room, ready to bolt for the sink. “Is that like a—a brand name or something?”
    “Not a brand name,” said Tierney. “Catgut is a type of surgical thread made from the intestines of cows or sheep.”
    “So why do they call it catgut?” asked Rizzoli.
    “It goes back to the Middle Ages, when gut strings were used on musical instruments. The musicians referred to their instruments as their
kit
, and the strings were called
kitgut
. The word eventually became
catgut
. In surgery, this sort of suture is used to sew together deep layers of connective tissue. The body eventually breaks down the suture material and absorbs it.”
    “And where would he get this catgut suture?” Rizzoli looked at Moore. “Did you trace a source for it on Sterling?”
    “It’s almost impossible to identify a specific source,” said Moore. “Catgut suture’s manufactured by a dozen different companies, most of them in Asia. It’s still used in a number of foreign hospitals.”
    “Only foreign hospitals?”
    Tierney said, “There are now better alternatives. Catgut doesn’t have the strength or durability of synthetic sutures. I doubt many surgeons in the U.S. are currently using it.”
    “Why would our unsub use it at all?”
    “To maintain his visual field. To control the bleeding long enough so he can see what he’s doing. Our unsub is a very neat man.”
    Rizzoli pulled her hand from the wound. In her gloved palm was cupped a tiny clot of blood, like a bright red bead. “How skillful is he? Are we dealing with a doctor? Or a butcher?”
    “Clearly he has anatomical knowledge,” said Tierney. “I have no doubt he’s done this before.”
    Moore took a step backward from the table, recoiling from the thought of what Elena Ortiz must have suffered, yet unable to keep the images at bay. The aftermath lay right in front of him, staring with open eyes.
    He turned, startled, as instruments clattered on the metal tray. The morgue attendant had pushed the tray next to Dr. Tierney, in preparation for the Y-incision. Now the attendant leaned forward and stared into the abdominal wound.
    “So what happens to it?” he asked. “Once he whacks out the uterus, what does he do with it?”
    “We don’t know,” said Tierney. “The organs have never been found.”

     

two
    M oore stood on the sidewalk in the South End neighborhood where Elena Ortiz had died. Once this had been a street of tired rooming houses, a shabby backwater neighborhood separated by railroad tracks from the more desirable northern half of Boston. But a growing city is a ravening creature, always in search of new land, and railroad tracks are no barrier to the hungry gaze of developers. A new generation of Bostonians had discovered the South End, and the old rooming houses were gradually being converted to apartment buildings.
    Elena Ortiz lived in just such a building. Though the views from her second-story apartment were uninspiring—her windows faced a Laundromat across the street—the building did offer a treasured amenity rarely found in the city of Boston: tenant parking, crammed into the adjacent alley.
    Moore walked down that alley now, scanning the windows in the apartments above, wondering who at that moment was looking down at him. Nothing moved behind the windows’ glassy eyes. The tenants facing this alley had already been interviewed; none had offered any useful information.
    He stopped beneath Elena Ortiz’s bathroom window and stared up at the fire escape leading to it. The ladder was pulled up and latched in the retracted position. On the night Elena Ortiz died, a tenant’s car had been parked just beneath the fire escape. Size 8 1 / 2 shoe prints were later found on the car’s roof. The unsub had used it as a stepping-stone to reach the fire escape.
    He saw that the bathroom window was shut. It had not been shut the night she met her killer.
    He left the alley, circled back to the front entrance, and let