Warnings this chapter: autopsy details.

CHAPTER 4

CAUSE OF DEATH

Across the street from the Trevor flat, a crowd of people had gathered behind the police lines. Two men watched with particular attention at the comings and goings of the forensics team and Lestrade's people. A stocky but muscular man—look in the dictionary under thug and his picture would be there—about 30, was impatient and unsmiling. A slightly built man in his early 50s watched with steady concentration. His interest piqued when he saw D.I. Lestrade, clearly the person in charge, leave the flat. When Sherlock Holmes and John Watson followed moments later, the man smiled and nudged his associate.

His smile widened when he saw Holmes and Watson take different cabs. He and the thug pushed their way to the kerb and hailed another cab. As he shut the door behind them, the older man said to the driver, "Damn! My mate just left without us in that cab"—he pointed to the taxi in question—"Would you mind—?" He waved a £10 note in the man's face. The cabbie grinned and took off in pursuit.

oOo

Molly had already done the preliminary work, and had made the customary Y-cut into Mrs Trevor's body cavity by the time John arrived.

"Oh, hello, so happy you could come. I mean, I'm not happy. Well, it's good. I mean, you're welcome to…"

John flashed a comforting smile. "Relax, Molly, I don't bite."

"Of course you don't. Silly thought." Molly flushed and John could see her—he could see her—mentally envisioning John gently biting her neck.

John cleared this throat and quickly gestured to the autopsy table. "Shall we? This is your area, so I'll just bow to your expertise."

Molly blushed again. She couldn't remember the last time anyone complimented her. "Where's Sherlock? Will he be along?"

"Nope. He's off with Lestrade." Her expression changed, and John wasn't sure if she was relieved or disappointed. She was certainly less nervous. He mentally chastised Sherlock for all the indignities he had foisted upon this sweet woman.

"Right, then…" Molly filled John in on the preliminary physical findings, which included confirming his observations on the hand bruising.

"There was nothing remarkable externally, aside from the bruising. And as you said at the scene—well, I wasn't there, but, of course I wasn't there, I was here, having some nibbles actually, and… well, the notes say…the notes Lestrade…" She took a breath. "Lestrade sent me your comments, and you're right, there are none of the expected signs of poisoning. So…so… Sorry, it feels a bit odd without—"

"Sherlock."

"Sherlock. Yes. Oh, God, I'm sorry, that was a terrible thing to say."

"It's fine, Molly. No offence."

She blushed again, stammered, and finally said, "All right, then. Let's have a look inside, shall we?"

"Hmm. Right."

Molly expertly folded open the tissue, then sawed the ribs and cut away the chest wall, exposing the organs. John's eyes were drawn immediately to the heart. Molly saw it too, judging by the slight gasp.

"Cardiac tamponade," she said.

"Yes."

Molly finished opening the pericardial cavity. "Oh, look, she's got a congenital sternal foramen," she said with a bit of excitement. "Don't see that often!"

"I've never seen one before."

"Hmmm, the foramen was perforated by something small…which then went through to the heart here." She pointed out a 3mm tear. "Undetected, this would easily cause tamponade and kill her if not treated immediately. Looks like there could be as much as 300cc's of blood in the sac. And, look, John, the lungs are hyperinflated—classic asthma presentation. If she'd been having an attack during the tamponade, she would have been tachy—"

"Heart beats faster, the tamponade would have killed her even more quickly."

Molly nodded, and he noted how confidently Molly spoke when she was on her own turf. Not a stutter or stammer to be heard.

"I don't understand. There were no external signs of trauma other than the various acupuncture sites," she said.

This couldn't really be death by acupuncture. Could it?

"Show me, Molly."

Molly folded back the skin of what used to be Mrs Trevor, and pulled down the overhead magnifier. They scanned the full torso.

They looked at the various pinpoint marks, some almost too small to see. But one stood out, larger than the others. It hadn't left a bruise, but obviously a larger gauge needle was used. The point was by the fourth intercostal space of the ribs—near the heart. The puncture did not line up directly with the tear; the needle would have had to have been angled to penetrate the heart.

"We might have to bring in an acupuncturist. I'm out of my depth here," John said.

"Just a sec," Molly pulled out a large chart showing acupuncture points and hung it from a clip. "Thought we might be needing this. Borrowed it from the chap upstairs in the Acupuncture Clinic."

John smiled. "Molly, you are the most underestimated woman in the universe."

Now it was her turn to smile. She started to fold back the skin over the body. "Oh, sorry. I shouldn't be smiling when I do this, should I?"

"Suppose not."

She put on her neutral facial expression, and proceeded to precisely line up the two sections. She checked the acupuncture chart. "Looks like it could be Shanzhong REN-17?"

John went to the computer and typed in a few phrases. "Says here that point can be used for treating asthma.… Molly, there's a caveat here, too. It says that a needle in that site should be inserted with caution, at a very precise angle"—he showed her the illustration—"or it could risk…well, this…" he said, indicating the heart, "and that it should never be inserted deeper than 2.5cm."

John went very quiet.

"John?"

"This was much deeper than that. At least 3.25, would you say?"

"Um, yes."

"The angle—"

"Um, yes."

"Had to be deliberate."

"Um, yes."

oOo

It was past noon as John spoke quickly into his mobile as he made his way through the corridors of St. Bart's toward the street.

"Molly hasn't finished the full autopsy, but Sherlock, it was a homicide. The acupuncturist."

Sherlock was already back at Baker Street. He shifted in his chair, readjusting the phone to his ear. "No, it wasn't, John. Lestrade and I have just come from the acupuncturist's. Dr Esther Levine, Doctor of Traditional Chinese Medicine, has a solid alibi."

They'd found the acupuncture office name—London Acupuncture and Herbs—in Mrs Trevor's diary, and he and Lestrade immediately put the doctor at the head of their suspect list.

Sherlock could still hear the reprimand in Dr Levine's voice when they showed surprise at seeing her—young, 29 at most, natural blonde, Uni grad, majored Mandarin, graduate of Glyndwr University of Traditional Chinese Medicine—and not some wizened Asian man. "Really, Mr Holmes, stereotyping? I would have expected a more open mind from someone of your reputation. And Detective Inspector, you, as well. Shame on you both." Sherlock had just stiffened but Lestrade had turned a bright red, like he'd been chastised by his mum in front of his school mates.

"Dr Levine," Sherlock continued as John tried to get a word in edgewise, "had a full day of appointments yesterday. Mrs Trevor, in fact, cancelled her appointment and a walk-in filled her spot. Levine never left the office yesterday, not even for lunch."

"I'm telling you, Sherlock, that Molly and I just saw the evidence! Mrs Trevor was killed by a deliberate insertion of an acupuncture needle into the heart."

That got his attention.

John was on the street now and walking quickly toward the kerb. There were several taxis approaching. He raised his hand to flag one down.

"Did you hear me, Sherlock?" John asked at the rare silence from the other end.

"Thinking... A revisit to Dr Levine is in order."

The taxi pulled to the kerb. Mobile still to his ear, John did not hear the burly man with the threatening expression quickly approaching him from behind.

oOo

Author's Note: Glyndwr University of Traditional Chinese Medicine is a real school. Apologies to all acupuncture experts out there for any mistakes or inaccuracies. My own acupuncturist looked at me funny when I kept pressing for the names of some of the points he was using; I didn't dare tell him why I wanted to know.