The Sinner (18 page)

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? Where the anterior nasal spine should be?”
Cawley
traced her finger down what should have been the slope of the nose.
“There’s
been advanced bone atrophy. In fact, there’s almost complete obliteration
of
the nasal spine.” She crossed to the shelf of skulls and took one down.
“Here,
let me show you an example. This particular skull was exhumed from a medieval
grave
site in Denmark. It was buried in a desolate spot, far outside the churchyard.
You
see here, where inflammatory changes have destroyed so much bony tissue that
there’s
just a gaping hole where the nose would be. If we were to boil off the soft
tissues
from your victim there—” She pointed to the X ray “—her
skull
would look very much like this one.”

“It’s not postmortem damage? Could the nasal spine have
been
cracked off when the face was excised?”

“It wouldn’t account for the severity of changes I see
on
that X ray. And there’s more.” Dr. Cawley set down the skull and
pointed
to the film. “You’ve got atrophy and recession of the maxillary bone.
It’s
so severe that the front upper teeth have been undermined and have fallen
out.”

“I’d assumed it was due to poor dental care.”

“That may have contributed. But this is something else. This
is
far more than just advanced gum disease.” She looked at Maura. “Did
you
do the other X-ray projections I suggested?”

“They’re in the envelope. We did a reverse Waters shot
as
well as a peri-apical series to highlight the maxillary landmarks.”

Cawley reached inside and pulled out more X rays. She clipped up a
peri-apical film, showing the floor of the nasal cavity. For a moment she said
nothing,
her gaze transfixed by the white glow of bone.

“I haven’t seen a case like this in years,” she
murmured
in wonder.

“Then the X rays are diagnostic?”

Dr. Cawley seemed to shake herself from her trance. She turned and
picked up the skull from her desk. “Here,” she said, turning the skull
upside down to show the bony roof of the hard palate. “Do you see how
there’s
been pitting and atrophy of the alveolar process of the maxilla? Inflammation
has
eaten away this bone. The gums have receded so badly that the front teeth fell
out.
But the atrophy didn’t stop there. Inflammation continued to chew away at
the
bone, destroying not just the palate, but also the turbinate bones inside the
nose.
The face was literally eaten away, from the inside, until the hard palate
perforated
and collapsed.”

“And how disfigured would this woman have been?”

Cawley turned and looked at the X ray of Rat Lady. “If this
were
medieval times, she would have been an object of horror.”

“Then this is enough for you to make a diagnosis?”

Dr. Cawley nodded. “This woman almost certainly had
Hansen’s
disease.”

T
HIRTEEN

T
HE NAME SOUNDED INNOCUOUS
enough to those who did
not
recognize its meaning. But the disease had another name as well, a name that
rang
with ancient echoes of horror: leprosy. It conjured up medieval images of robed
untouchables
hiding their faces, of the shunned and pitiful, begging for alms. Of
leper’s
bells, tinkling to warn the unwary that a monster approaches.

Such monsters were merely the victims of a microscopic invader:
Mycobacterium
leprae,
a slow-growing bacillus that disfigures as it multiplies, rippling
the
skin with ugly nodules. It destroys nerves to the hands and feet so that the
victim
no longer senses pain, no longer flinches from injury, leaving his limbs
vulnerable
to burns and trauma and infection. With the passage of years, the mutilation
continues.
The nodules thicken, the bridge of the nose collapses. The fingers and toes,
repeatedly
injured, begin to melt away. And when the sufferer finally dies, he is not
buried
in the churchyard, but is banished far beyond its walls.

Even in death, the leper was shunned.

“To see a patient in such an advanced stage is almost unheard
of in the U.S.,” said Dr. Cawley. “Modern medical care would arrest
the
disease long before it caused this much disfigurement. Three-drug therapy can
cure
even the worst cases of lepromatous leprosy.”

“I’m assuming this woman
has
been treated,”
said
Maura. “Since I saw no active bacilli in her skin biopsies.”

“Yes, but treatment obviously came late for her. Look at
these
deformities. The loss of teeth and the collapse of facial bones. She was
infected
for quite some time—probably decades—before she received any
care.”

“Even the poorest patient in this country would have found
treatment.”

“You’d certainly hope so. Because Hansen’s disease
is
a public health issue.”

“Then the chances are this woman was an immigrant.”

Cawley nodded. “You can still find it among some rural
populations
around the world. The majority of cases worldwide are in only five
countries.”

“Which ones?”

“Brazil and Bangladesh. Indonesia and Myanmar. And, of
course,
India.”

Dr. Cawley returned the skull to the shelf, then gathered up the
photos
on her desk and shuffled them together. But Maura was scarcely aware of the
other
woman’s movements. She stared at the X ray of Rat Lady, and thought of
another
victim, another death scene. Of spilled blood, in the shadow of a crucifix.

India, she thought. Sister Ursula worked in India.

Graystones Abbey seemed colder and more desolate than ever when
Maura
stepped through the gate that afternoon. Ancient Sister Isabel led the way
across
the courtyard, her L. L. Bean snow boots peeking out incongruously from beneath
the
hem of her black habit. When winter turns brutal, even nuns rely on the comfort
of
Gore-Tex.

Sister Isabel directed Maura into the Abbess’s empty office,
then
she vanished down the dark hallway, the clomp-clomp of her boots trailing a
fading
echo.

Maura touched the cast-iron radiator beside her; it was cold. She
did
not take off her coat.

So much time passed that she began to wonder if she had been
forgotten,
if the antique Sister Isabel had simply shuffled on down the hall, her memory of
Maura’s arrival fading with each step. Listening to the creaks of the
building,
to the gusts rattling the window, Maura imagined spending a lifetime under this
roof.
The years of silence and prayer, the unchanging rituals. There would be comfort
in
it, she thought. The ease of knowing, at each dawn, how the day will go. No
surprises,
no turmoil. You rise from bed and reach for the same clothing, kneel for the
same
prayers, walk the same dim corridors to breakfast. Outside the walls,
women’s
hems might rise and fall, cars might take on new shapes and colors, and a
changing
galaxy of movie stars would appear and then vanish from the silver screen. But
within
the walls, the rituals continue unchanging, even as your body grows infirm, your
hands unsteady, the world more silent as your hearing fades.

Solace, thought Maura. Contentment. Yes, these were reasons to
withdraw
from the world, reasons she understood.

She did not hear Mary Clement’s approach, and she was
startled
to notice the Abbess was standing in the doorway, watching her.

“Reverend Mother.”

“I understand you have more questions?”

“About Sister Ursula.”

Mary Clement glided into the room and settled in behind her desk.
On
this bitterly cold day, even she was not immune to winter’s chill; beneath
her
veil, she wore a gray wool sweater embroidered with white cats. She folded her
hands
on the desk and fixed Maura with a hard look. Not the friendly face that had
greeted
her on that first morning.

“You’ve done all you can to disrupt our lives. To
destroy
the memory of Sister Camille. And now you want to repeat the process with Sister
Ursula?”

“She would want us to find her attacker.”

“And what terrible secrets do you imagine she has? Which sins
are you now fishing for, Dr. Isles?”

“Not sins, necessarily.”

“Just a few days ago, you were focused only on Camille.”

“And that may have distracted us from probing more deeply
into
Sister Ursula’s life.”

“You’ll find no scandals there.”

“I’m not looking for scandals. I’m looking for the
attacker’s
motive.”

“To kill a sixty-eight-year-old nun?” Mary Clement shook
her head. “There’s no rational motive that I could imagine.”

“You told us that Sister Ursula served a mission abroad. In
India.”

The abrupt change in subject seemed to startle Mary Clement. She
rocked
back in her chair. “Why is that relevant?”

“Tell me more. About her time in India.”

“I’m not sure what you want to know, exactly.”

“She was trained as a nurse?”

“Yes. She worked in a small village outside the city of
Hyderabad.
She was there for about five years.”

“And she returned to Graystones a year ago?”

“In January.”

“Did she talk much, about her work there?”

“No.”

“She served five years there, and she never spoke of her
experiences?”

“We value silence here. Not idle chatter.”

“I’d hardly consider it idle chatter to talk about her
mission
abroad.”

“Have you ever lived abroad, Dr. Isles? I don’t mean in
a
nice tourist hotel, where maids change the sheets every day. I’m talking
about
villages where sewage runs in the street, and children are dying of cholera. Her
experience there wasn’t a particularly pleasant topic to talk about.”

“You told us there’d been violence in India. That the
village
where she worked was attacked.”

The Abbess’s gaze dropped to her hands, the skin chapped and
red,
folded on the desk.

“Reverend Mother?” said Maura.

“I don’t know the whole story. She never spoke of it to
me.
What little I do know, I heard from Father Doolin.”

“Who is that?”

“He serves in the archdiocese in Hyderabad. He called from
India,
right after it happened, to tell me that Sister Ursula was returning to
Graystones.
That she wished to rejoin cloistered life. We welcomed her back, of course. This
is her home. Naturally, this was where she came to find solace, after . .
.”

“After what, Reverend Mother?”

“The massacre. In Bara village.”

The window suddenly rattled, buffeted by a gust. Beyond the glass,
the day was leached of all color. A gray wall, topped by gray sky.

“That was where she worked?” asked Maura.

Mary Clement nodded. “A village so poor it had no telephones,
no electricity. Nearly a hundred people lived there, but few outsiders dared to
visit.
That was the life our sister chose, to serve the most wretched people on
earth.”

Maura thought of Rat Lady’s autopsy. Of her skull, deformed
by
disease. She said, softly: “It was a leper’s village.”

Mary Clement nodded. “In India, they’re considered the
most
unclean of all. Despised and feared. Cast out by their families. They live in
special
villages, where they can retreat from society, where they don’t have to
hide
their faces. Where others are as deformed as they are.” She looked at
Maura.
“Even that didn’t protect them from attack. Bara village no longer
exists.”

“You said there was a massacre.”

“That’s what Father Doolin called it. Mass
slaughter.”

“By whom?”

“The police never identified the attackers. It could have
been
a caste massacre. Or it could have been Hindu fundamentalists, angry about a
Catholic
nun living in their midst. Or they could have been Tamils, or any one of half a
dozen
separatist factions at war there. They killed everyone, Dr. Isles. Women,
children.
Two of the nurses in the clinic.”

“But Ursula survived.”

“Because she wasn’t in Bara that night. She’d left
the
day before to fetch medical supplies from Hyderabad. When she returned the next
morning,
she found the village in ashes. Workers from the nearby factory were already
there,
searching for survivors, but they found none. Even the animals—the
chickens,
the goats—were slaughtered, and the corpses burned. Sister Ursula collapsed
when she saw the bodies, and a doctor from the factory had to keep her in his
clinic
until Father Doolin arrived. She was the only one from Bara who survived, Dr.
Isles.
She was the lucky one.”

The lucky one, thought Maura. Spared from slaughter, only to come
home
to Graystones Abbey and find that Death had not forgotten her. That even here,
she
could not escape his hand.

Mary Clement’s gaze met Maura’s. “You’ll find
nothing
shameful in her past. Only a lifetime of service in God’s name. Leave our
sister’s
memory alone, Dr. Isles. Leave her at peace.”

Maura and Rizzoli stood on the sidewalk outside what had once
been
Mama Cortina’s restaurant, and the wind sliced like an icy blade through
their
coats. It was the first time Maura had viewed this scene in daylight, and she
saw
a street of abandoned buildings, and windows that stared down like empty eye
sockets.

“Nice neighborhood you’ve brought me to,” said
Rizzoli.
She looked up at the faded sign for Mama Cortina’s. “Your Jane Doe was
found in there?”

“In the men’s bathroom. She’d been dead about
thirty-six
hours when I examined her.”

“And you’ve got no leads on her ID?”

Maura shook her head. “Considering her advanced stage of
Hansen’s
disease, there’s a good chance she was a recent immigrant. Possibly
undocumented.”

Rizzoli hugged her coat tighter.
“Ben-Hur,”
she
murmured.
“That’s what it makes me think of. The Valley of the Lepers.”

“
Ben-Hur
was just a movie.”

“But the disease is real. What it does to your face, your
hands.”

“It can be highly mutilating. That’s what terrified the
ancients.
Why just the sight of a leper could send people screaming in horror.”

“Jesus. To think we have it right here in Boston.”
Rizzoli
shuddered. “It’s freezing. Let’s get inside.”

They stepped into the alley, their shoes crunching along the icy
trough
that had formed from the footsteps of so many law enforcement officers. Here
they
might be protected from the wind, but the well of gloom between the buildings
felt
somehow colder, the air ominously still. Police tape lay across the threshold of
the restaurant’s alley doorway.

Maura took out the key and inserted it in the padlock, but it
would
not pop open. She crouched down, jiggling the key in the frozen lock.

“Why do their fingers fall off?” asked Rizzoli.

“What?”

“When you catch leprosy. Why do you lose your fingers? Does
it
attack the skin, like flesh-eating bacteria?”

“No, it does its damage in a different way. The leprosy
bacillus
attacks the peripheral nerves, so your fingers and toes go numb. You can’t
feel
any pain. Pain is our warning system, part of our defense mechanism against
injury.
Without it, you could accidentally stick your fingers in boiling hot water, and
not
sense that your skin’s being burned. Or you don’t feel that blister
building
on your foot. You can injure yourself again and again, leading to secondary
infections.
Gangrene.” Maura paused, frustrated by the stubborn lock.

“Here. Let me try.”

Maura stepped aside and gratefully slipped her gloved hands in her
pockets while Rizzoli jiggled the key.

“In poorer countries,” said Maura, “it’s the
rats
that do the actual damage to hands and feet.”

Rizzoli looked up with a frown. “Rats?”

“In the night, while you’re sleeping. They crawl onto
your
bed and gnaw on fingers and toes.”

“You’re serious?”

“And you don’t feel a thing, because leprosy has made
your
skin numb. When you wake up the next morning, you discover the tips of your
fingers
are gone. That all you’ve got left are bloody stumps.”

Rizzoli stared at her, then gave the key a sharp twist.

The padlock popped open. The door swung ajar, to reveal shades of
gray
blending into blackness.

“Welcome to Mama Cortina’s,” said Maura.

Rizzoli paused on the threshold, her Maglite beam cutting across
the
room. “Something’s moving inside,” she murmured.

“Rats.”

“Let’s not talk any more about rats.”

Maura switched on her own flashlight and followed Rizzoli into a
darkness
that smelled of rancid grease.

“He brought her through here, into the dining room,”
said
Maura, her flashlight playing across the floor. “They found some drag marks
through the dust, probably left by the heels of her shoes. He must have grasped
her
under the arms and hauled her backwards.”