Shadows Fall by J.K. Hogan

Karen said, while systematically working to remove the rest of the organs. “While our guy clearly has at least rudimentary medical knowledge—maybe more—the organ definitely was not removed with preservation in mind. It was a removal for removal’s sake.”
    “But why would he do that?” David asked.
    “Indeed, young David. Indeed,” Charlie said. That was the million dollar question.
    “Karen, did you find anything in the initial exam before I got here?” Charlie had been delayed by a bothersome young reporter who’d gotten a lucky tip, and Dr. Johanssen had been just about to start the dissection when he’d arrived.
    “Yes, actually. She had a severe case of jaundice which could indicate advanced liver failure. Without examining the actual liver, it’s hard to be sure, but I may come up with a root cause in the serology or microscopic examination. Lots of diseases can cause liver failure. Hepatitis in its various iterations, fatty liver disease… alcohol abuse, drug toxicity, cancer—although I’d have surely found evidence of those somewhere else within the body. Could also be an autoimmune disease she’s had since birth—really any bilirubin processing disorder.”
    “English, Doc.”
    “Sorry,” Karen muttered, not looking a bit sorry. “In laymen’s terms, she had a bum liver, but it will take much longer to figure out why without being able to examine the actual liver. This could be a break for you though…”
    “How the hell…?”
    “She seemed to otherwise have been taken really good care of. It’s likely that if she had some kind of liver disease, she or her family would have sought treatment for it. Surely she’s got extensive medical records out there somewhere—hell, she might even be on a transplant list. Maybe that could provide you with some clues.”
    Charlie’s heart leapt. This case had been one frustration after another, from the sheer lack of information. Any little bit would help. “Karen, you’re a genius.”
    “Yes, I know.”
    Charlie had to force himself not to look away as Karen finished removing the girl’s organs and handing them to David for washing, weighing, and bread-slicing for tissue samples. He wasn’t squeamish at all, not even a little, but something about the dehumanization factor of an autopsy—reducing a formerly living, breathing person to nothing but a sum of her parts—always disturbed him on some level.
    “Oh, and we found the neck markings again,” Karen said as she was running the bowel—palpating the small and large intestine to check for any injuries or abnormalities. “Hers were slightly different, as per usual, but definitely the same type of cuts. Put on some gloves and have a look before I have to reflect the skin.”
    Grabbing some plastic gloves from a dispenser on the wall, Charlie went around to the far side of the exam table and gently tilted the girl’s head to the right so that he could have a look at her neck. It was the same M.O. as before. Slashes, circles, all arranged in a block pattern, scored into the skin.
    “His signature,” he said.
    “If it’s the same guy.”
    “Don’t start that again, Karen. I’ve got four bodies and almost no evidence. The only unifying factors are these markings, the fact that they all died from massive blood loss due to different wounds, and they were all female.”
    Karen froze. “Shit… maybe not.”
    “What, blood loss? Did something else kill her?”
    “No… female.”
    “So what, she’s transgendered?”
    Karen was concentrating hard on separating a particular organ from the surrounding tissue. She didn’t look up at him. “Not exactly.”
    “Jesus, Karen! Could you stop being so fucking cryptic?”
    She paused, raising her hands up as she glared at him. “I’m kind of doing a couple of things at once here, so back the fuck off, detective. ”
    Sighing, Charlie tried to reach down deep into his inner well of patience and pull some out. “Sorry. You were