Arrested Autolysis

Dr. Eleanor Vane did not believe in things that could not be measured, and she came in at four in the morning to prove it.

Nasrin heard her on the stairs before she saw her, the particular clip of those low court shoes that never hurried and never dawdled, a metronome of a woman descending into the basement against all sense. Most consultants signed off post-mortems by daylight, from photographs, with a technician's notes to lean on. Vane had asked, on the phone, in a voice scraped flat by sleeplessness, whether the body from drawer nine was still cold. Nasrin had said it was as cold as she could make it. Vane had said good, do not let it get warm, and hung up.

The post-mortem room was the cleanest room in St Bride's by a distance, and Nasrin kept it that way the way some people kept a grave. White tile to shoulder height, a stainless table sloped to a drain, the down-draught vent humming over the smell of formalin and the older smell of bleach beneath it. She had laid out the tray herself, the long knife and the bowel scissors and the bone saw and the toothed forceps, each in its place, and she had checked the place of each one twice, because checking things in their places was a thing she did with her hands when the rest of her wanted to run.

"Mortuary's a fridge that's lost the will to live," Vane said, by way of hello, dragging the green gown over her cardigan. Sixty-something, grey bob cut to the jaw, half-moon glasses she looked over rather than through. Her hands, gloving up, were perfectly steady. Nasrin had watched those hands for two years and had not seen them shake. "You drew the short straw on nights again, Chowdhury. Or you volunteered. Which is worse."

"I prefer it down here," Nasrin said.

"Of course you do. No one talks back." Vane tied her mask. "Show me your peaceful death."

Nasrin slid drawer nine out on its runners. The cold came off it in a sheet, and under the cold came the smell, the one that had been living in the back of her throat for six nights now, sweet and round and faintly warm at the edges of itself, dates and caramel and roses left a day too long in the vase. She had told herself clostridial gas. She had told herself a hundred times. A gas-forming organism could turn a body sickly sweet, could puff it tight, could do strange fast things to tissue in a warm fridge. She had written exactly that in the log in her own neat hand and she had believed it for whole minutes at a time.

She drew back the sheet, and the belief did not survive the light.

The man was sixty-one, a retired bus driver named Arthur Finch who had died on the respiratory ward of a flu that turned to pneumonia, had died, the notes said, quietly, in his sleep, after telling the night nurse he was ready and that she should go and see to the others. He had been dead four days. He should have been the colour of old candle wax, marbled green at the belly, the gut beginning its slow loud work, the smell of him a wall you walked into. Instead the skin at his throat and along his forearms had gone faintly translucent, a clouded amber, as though somebody had begun the patient work of turning him into something you would hold up to a window. The pressure sore at his heel, an ulcer Nasrin had read at intake as a grade three, deep and ragged and owed an apology, had glazed over. Not healed. Glazed. A smooth golden caul lay across it like the burnt sugar on a custard, and it caught the light, and it was, she made herself say it in her own head, lovely.

Vane stood very still and looked at it for a long time.

"Tell me what I'm seeing," she said, "in your words, not the textbook's."

The smell reached up and turned a key in Nasrin that she had welded shut six years ago, and before she could stop it she was somewhere else. A side room on a surgical ward, gone three in the morning, a man's bare foot in her two hands and the dressing peeled back, and under the dressing a smell that was not the honest filth of an infected wound but something sweeter, rounder, almost edible, and her exhausted brain had filed it as nothing, as the iodoform, as the manuka they were packing it with, and she had redressed it and gone to her next patient, and by the dawn shift the redness had climbed his shin like a tide coming in. She had spent the rest of her life being a person who would never miss that smell again. And here it was. Here it was, in her room, on her table, four nights running.

Her stomach closed like a fist. Her hand, without instruction, went to the edge of the table and gripped it. She breathed in through her mouth, slow, the way she taught grieving daughters to breathe, and she put the ward and the foot and the man back into the box and shut the lid.

"The tissue's wrong," she said, and her voice came out level, which she was proud of. "There's no putrefaction. Four days, warm spells in this fridge, surge bodies stacked two to a bay, and there's no green, no marbling, no skin slip. No smell of death. He smells sweet." She paused. "He smelled sweet at intake. The next one did too. And the next."

"How many."

"Four. All from the surge. All of them died easy, that's the line the wards keep using, died easy, just let go." She heard herself and stopped.

Vane looked at her over the half-moons. "You think that's relevant. Manner of death."

"I think the ones that fought aren't doing this."

Vane said nothing to that. She took up the knife.

She worked the way she always worked, narrating for the recorder clipped to her gown, dry and exact, the Y-incision opening Arthur Finch from each shoulder to the sternum and down. Nasrin assisted the way she always assisted, present and quiet and ready before she was asked, and for a few minutes it was almost ordinary, two professionals doing the thing they were good at in the small hours, and the ordinariness was a mercy she clung to with both hands.

Then Vane stopped narrating.

"The fat," she said.

Nasrin leaned in. Subcutaneous fat should be firm and pale yellow and, four days dead, beginning to liquefy at the edges into the early grease of decomposition. This was neither. It had gone the colour of clear honey and it held a faint inner light, the way a thumb held to a torch glows red. When Vane pressed it with a gloved finger it gave, slow and even, and came back. It did not tear. It did not slough. It behaved like something alive and well, like the fat of a man asleep, except that the heart above it was not beating and had not beaten for four days.

"That doesn't decompose like that," Vane said. "That doesn't decompose at all."

She took her samples. Liver, spleen, lung, a wedge of the glazed heel, each into its pot. She handled them quickly, and Nasrin noticed, because noticing was her trade, that Vane held each pot a half-second longer than she needed to, as if confirming its weight, before she set it down.

"Sit," Vane said, and led the way to the path lab next door, peeling gloves.

The microscope was the one piece of equipment in the basement that worked properly, an old binocular thing Vane treated better than she treated people. She made her slides at the bench, fast and clean, the squelch of the cryostat, the dip and stain, and she fed the first one under the objective and bent to it. Nasrin stood at her shoulder and watched the back of her grey head not move.

"Autolysis," Vane said at last, to the eyepiece, not to Nasrin. "When a cell dies its own enzymes start eating it from the inside. Lysosomes rupture. The cell digests itself. It begins within minutes and it does not stop, it is the most reliable thing in my profession, it is gravity. By four days these cells should be ghosts. Smudges. The architecture should be gone."

"And?"

"The architecture is perfect." Vane's voice did not change and that was the frightening part. "Membranes intact. Nuclei intact. The enzymes have not finished the job. They have not, as far as I can see, started it." She straightened, took off the half-moons, polished them on her gown with two short strokes, put them back on, and bent again. "Autolysis arrested. I have read about it precisely never, because it does not occur. A dead cell is a falling cell. This is a cell that has been caught."

She slid a second preparation under the lens, the fresh wet one, the heel.

She said nothing for a long while. The lab hummed. Somewhere overhead a trolley crossed a join in the floor and the whole basement registered it as a far thud, and Nasrin's heart kept the time.

"Chowdhury," Vane said. "Come and look. Tell me I'm tired."

Nasrin bent to the eyepiece, and the warmth of Vane's face had left a fog on the rubber cup that she had to blink past, and then the field swam into focus and she was looking at the cured tissue of a dead man's heel at four hundred times.

It was beautiful. That was the first wrong thing. Decay under a microscope was a ruin, a city after a war, and this was not ruined. The cells stood in their proper courses, swollen with that honeyed inner light, the spaces between them filled with a fine glittering matrix that no stain she knew would lay down like that. And it was not still.

At first she thought it was her own pulse moving in her eye, the way the dark behind your lids swarms when you press them. But it had a direction. Within the cells, slow as the minute hand you can never catch crossing, the bright matter was creeping, gathering at the membranes, threading from one cell toward the next along fine gold filaments that had no business existing, building, reaching, the whole field shifting by degrees toward an arrangement it had not yet reached and was patiently, ceaselessly approaching. The tissue was not preserved. Preserved was a still word. This was being kept, and the keeping was a verb, and the verb was happening now, under glass, in her dead man, while she watched.

She stood up too fast. The room tilted and righted. Her gorge climbed and she swallowed it down, and her hands had gone cold and damp inside themselves, and the clinical part of her, the part that had a name for everything, reached for a name and found the drawer empty.

"That tissue is metabolising," she said. The words sounded mad in her own mouth. "It's dead and it's metabolising and it's, it's moving toward something."

"Yes." Vane was looking at the slide as though it were a door that had opened in a wall she had spent forty years calling solid. "It's organising. Dead tissue does not organise. Dead tissue surrenders to the second law and falls apart into simpler things. This is doing the opposite. This is assembling." She said it the way another person might say a prayer they did not believe and had started to. "I don't have a category for what is happening on this slide. In forty years I have never written that sentence."

Nasrin's throat was full of dates and caramel and the side room six years gone. She thought of Arthur Finch telling the nurse he was ready, go and see to the others. She thought of four men in four drawers who had let go, and had not been let go.

"We need to call someone," Nasrin said. "Public health. The HPA. This is, if it's transmissible, if it spreads, we need to."

"It is not in my power to call someone about a thing that does not exist," Vane said. "And I will not put my name to a notification that reads dead tissue is alive and building itself a future. They would retire me by lunchtime." She was still bent to the eyepiece. Then, slowly, she reached up and turned the fine focus a fraction, and went very still, and Nasrin watched the steady hands of Eleanor Vane, the hands that did not shake, do the thing she had never seen them do.

The right one trembled, once, on the brass knob, and stopped.

Vane straightened. She took the slide out from under the clips with great care, holding it flat and level as though it might pour, and she set it down on the steel bench, and she looked at it lying there small and bright, and she folded her unsteady hands together in front of her to keep them company.

"Chowdhury," she said, and her voice was perfectly calm, which was worse than any scream. "Be a good girl and fetch me the bleach."

Nasrin moved toward the cupboard.

"All of it," Vane said. "Every bottle in the building. Now."