AC05 - Death Mask (26 page)

Truth was subjective, Anya thought, but proving the statements were lies was a whole new ball game. Now Janson was not around to be cross-examined, his statement would stand.

Even in death he was still able to hurt Kirsten Byrne.

A
nya arrived at the Manhattan Medical Examiner’s office on First Avenue. Like so many other government institutions, the building was decades old and could have done with a facelift. Inside was worse. The mortuary, autopsy rooms, toxicology and histology labs, along with X-ray and photography facilities, were crammed into a few small floors.

The glamour, open space and proliferation of high-tech wizardry portrayed on some television dramas could not have been further from the reality.

Doctor Gail Lee was expecting Anya. Ethan had other business to attend to, and she was glad for the small amount of personal space. This trip had made her realise how much time she usually spent alone. Surprisingly, though, Ethan was proving better company and far less intrusive than most people she met.

Doctor Lee was in the midst of watering a brown-tipped fern on the filing cabinet in her office. When Anya knocked, she was wiping some water off a file beside the plant. Doctor Lee lowered her round, red-rimmed glasses and smiled warmly.

‘Anya Crichton, how long has it been?’

‘Four, maybe five years since the symposium. You presented sudden cardiac death, if I remember.’

Doctor Lee smiled. ‘We had a fascinating discussion about familial cardiomyopathy.’

The senior medical examiner had written countless articles on the pathology of sudden death and irregular heart rhythms.

She finished wiping the file. ‘Welcome to my neck of the woods.’

Her hair was still black but with a few grey hairs scattered through. What used to be waist length was now cut in a short bob with a straight fringe. The style reminded Anya of the character Edna in
The Incredibles
.

‘Please, take a seat.’

Anya looked around the cramped office and gathered from what she saw that Gail was a hoarder. Files, preserved specimens in glass, journals and papers covered every surface. The plant probably never stood a chance so close to the air conditioning, which was spewing air colder than necessary for comfort. A computer in the corner was the only obvious piece of technology.

‘Thanks. I’ve been investigating the veracity of a sexual assault claim against Peter Janson and some of his team mates. That’s why I was around when Janson’s body was discovered.’

Gail dug through a pile and pulled out the police report.

‘I agree time of death was within an hour of when you found him. Lividity was beginning to form in his legs, suggesting he’d died in that semi-upright position. Of course, toxicology will take a few weeks, or even longer given our backlog.’

In many ways, that would suit Janson’s family and the Bombers’ management. By then, media speculation about the death would have died down and the lasting memory in many people’s minds would be of the heart attack, as described by Gavin Rosseter.

‘I’m still waiting on the medical history from his family doctor. All I have is a health summary by the team doctor. Are you aware if he suffered from either depression or epilepsy?’

Anya sat forward. ‘Not that I know of.’ For the pathologist to ask that question, something had to be wrong on gross examination of the brain.

‘Do you think cause of death was something other than asphyxia?’

The woman handed over a number of photographs. ‘What do you make of the gross findings on the brain?’

Anya studied the images. A shiny light brown layer of what looked like scar tissue lay on the surface of the frontal lobe of the brain.

‘He had a head injury at a game the other day but got up and kept playing, and was apparently fine after that.’ There was the possibility of a bleed between the lining of the brain and the skull, known as an extradural haemorrhage. Sufferers could be lucid and conscious after a head injury then deteriorate as the bleed increased in size and put pressure on the brain.

‘What about an extradural?’

‘Nothing to suggest it.’ She pulled out a series of photographs with similar images. ‘This one is of a boxer who fought for twenty years, then killed himself at the age of thirty-seven. Compare this to that of a seventy-five-year-old dementia patient.’ She pointed to one that looked almost identical. ‘Janson’s lies somewhere in between.’

‘His doesn’t appear to be from an acute injury, like the one he sustained the other day. It looks more like a scar than a haematoma.’

‘That’s my thinking. The sort of scar that happens when the head is used as some kind of battering ram or punching bag – again and again.’

Anya sat back in amazement. ‘But he was only twenty-seven, and I’ve seen the helmets. They’re padded with foam and inflatable sections customised to the shape of the player’s head. There’s no chance of it slipping either. Those helmets move with the skull and, I would have thought, absorb a lot of force.’

‘I did a literature search and it seems what I found in Pete Janson – although we do have to wait until the brain is fixed and dissected – is that he had CTE.’

Anya had heard of chronic traumatic encephalopathy. The first cases had been reported in former boxers, of whom it was
thought twenty percent would develop it. Recent data suggested that percentage was, in fact, much higher. If what Gail said about Peter Janson’s brain was true, the repeated trauma from his sport would have caused irreversible brain damage. She thought back to the game and the number of audible collisions in each play during the short period she had been on the sideline.

Gail said, ‘I’d be keen to know if he suffered personality changes – extreme aggression, loss of inhibition, forgetfulness and intractable depression. The former players who have been studied each committed suicide. With the degree of damage to Janson’s cortex, I can’t exclude it.’

‘He was accused of raping a woman last week. She apparently went to discuss a business proposal and he assumed she was there for sex. He went to the bathroom and returned naked from the waist down.’

Gail tapped a pencil on the desk. ‘Sounds like disinhibition from frontal lobe destruction.’

‘Or a sign of overt aggression. It’s difficult to know if that was new or part of his personality in the first place. These men are trained to be brutal and don’t necessarily understand how to switch that off.’

‘That is disturbing.’ Gail shook her head. ‘Any signs of depression since he was accused of rape? Surely that would have affected his career prospects and had a significant impact on his family. Shame, embarrassment, remorse.’

Anya doubted that. ‘Janson seemed pretty cocky and was apparently with another woman in his room just before his death. We have no idea at this stage who that woman was, although we assume it wasn’t his wife.’

‘Living with a cat is far less trouble,’ Gail muttered. ‘It always amazes me how people with fame and success manage to complicate their lives.’

‘He has been accused of rape before. I suspect the sexual aggression has been going on a long time.’

‘In relative terms, so might the brain damage.’

Gail made a good point. Anya appreciated that complete examination of the brain tissue would take more than a couple of weeks. First, the entire organ would have to be fixed in formaldehyde then dissected into shavings smaller than a hair in thickness. Special immunological stains were used to reveal the presence of abnormal proteins. What Gail would be looking for was tau protein in the absence of beta-amyloid – the indicator for CTE. Patients with Alzheimer’s characteristically had distinctive patterns of the two different proteins. Beta-amyloid correlated with the earlier stages of brain deterioration. As the disease progressed, tau protein became more prevalent and was thought to cause severe and permanent damage to brain cells.

This had raised the question of how many patients treated in Alzheimer’s facilities were the victims of head trauma, possibly from contact sports earlier in life. Unfortunately, the answer would only ever be found at post-mortem.

Because Janson’s brain showed such similarities to that of a boxer or an elderly dementia patient, the diagnosis of CTE was a strong possibility.

Gail removed her glasses, revealing a pressure mark at the bridge of her nose. ‘I want to run a test for APoE4 which, as you know, appears to predispose certain people to trauma-related brain injury.’

Anya was familiar with the apoprotein. Studies had shown that patients who tested positive for the gene component released more tau protein into the cerebrospinal fluid following a head injury than people who tested negative. That meant more permanent damage was likely in the positive patient. Potentially, parents might demand the right to know if their children were predisposed to brain damage before they commenced contact sports. It would be a legal minefield.

‘That’s a good idea. You’ll know a lot more if you identify tau protein in the absence of beta-amyloid in Janson’s brain. CTE may not have been the direct cause of death, but it could have been a contributing factor.’

The air conditioner clunked and the room became even
colder. Anya pulled on her cardigan. ‘What do you think about auto-erotic asphyxia?’

The red glasses were back in position. ‘That’s tricky because it appears the scene was disturbed without being photographed.’

‘Actually, I took some shots on my phone before the body was interfered with.’ Anya lifted her bag onto her lap. ‘Force of habit. They may not be great quality, but they give the layout of the room and position of the body.’ Again, she was grateful the device had been returned.

‘If you don’t mind, just email them. That way they’ll be on file. Our online security is as good as it gets.’

Anya put the bag back at her feet.

‘Was there any history of his practising it, or any sexual paraphernalia, pornography, bondage equipment at the scene?’

‘No. But he was naked, wearing a condom.’

Gail steepled her fingers together. ‘That is highly suggestive.’

The doctor’s phone rang but she ignored it. She readjusted her glasses as she read the file. ‘If he were a regular practitioner, I would have expected him to use something to protect his neck from bruising by the belt. Particularly, as I keep being reminded, because he was in the public eye.’

Anya had to agree. The bodies she had seen sometimes presented with a towel or cloth around the neck beneath the ligature to prevent bruising.

‘Suicide is still a possibility,’ Gail said. ‘Either way, it’s such a waste of life. The condom is curious, but could have been part of some bizarre sexual ritual.’

Anya thought suicide was a long shot. Janson had children and a wife to live for, and he seemed to revel in the adulation and privileges fame and money brought.

‘He seemed to have a rapacious sexual appetite, not that he was unique in terms of celebrities or sportsmen. But there is the issue of that woman in his room before he died.’

The pathologist scanned her desk a number of times. ‘There were no signs of a fight, and three hundred pounds would be difficult to choke while he was conscious. The blood alcohol
level was 0.05, not enough to render him incapacitated. As I mentioned, bloods have been sent off for tox screening so we’ll know more then. Homicide isn’t high on my agenda, but I have been proven wrong before.’

Gail pulled at one of her small silver earrings. ‘He had a significant number of gastric erosions, my guess is from taking ibuprofen or the equivalent. From what I can gather, athletes pop them like jellybeans. There is something else of interest, but unrelated to the specific cause of death.’

She located an image of the top half of Janson’s face. ‘Two and a half inches behind the hairline is scarring. There’s no loss of hair, so the procedure was probably elective and I assume cosmetic, although it’s something I’m not familiar with.’ She held X-rays of the head – front and profile – up to the ceiling lights.

‘This man seems to have had work done to his frontal bone – again, not documented in the medical history I was given.’

Anya tried to work out why anyone would need to shave back the bone beneath his forehead. Unless, she thought, he had illegally used growth hormone and developed visable side effects like thickening of the skull and jaw. If it had begun to change his appearance, the doping agencies could become suspicious. So his enablers could have organised a cosmetic surgeon to make the effects less obvious, completely disregarding the dangers to his health of continuing to use the illegal drugs.

She sat back, horrified at the possibility. It was the only logical explanation.

Despite having little sympathy for the way Janson behaved, he was, she suspected, partly a victim of his handlers and the insatiable push to win.

‘Were there any identifiable signs of anabolic steroid abuse? Any scars, scabs, abscesses from possible injection sites?’

Gail referred to her notes. ‘As you would anticipate, his physique was very muscular and he had large hands, feet and a prominent jaw, but not out of place in a person his size. There was a torn bicep muscle on the left, but nothing else you would
expect, like acne or testicular atrophy. The heart was enlarged and hypertrophied, but not out of the ordinary for an athlete.’

So far, Anya thought, nothing stood out, although anecdotally players who used steroids ruptured muscles more easily than non-users. There was nothing tangible to confirm he had taken them.

Gail continued. ‘There was some scar tissue present in the upper outer quadrants of both buttocks, but the team doctor had prescribed vitamin B injections for fatigue, apparently.’ She scowled. ‘What athlete isn’t going to be fatigued with all the weightlifting and training he would have done? Not to mention being slammed at great speed into other massive objects.’

Anya knew that blood tests after death were unlikely to be of help in any diagnosis of illegal steroid use. Janson wasn’t about to pee into a cup.

‘I contacted a friend who’s a neuropathologist and he agrees it looks like another case of CTE. I told him about your interest in the case. He’s got time to meet you today up until two o’clock if you’d like.’ She wrote down his contact details. ‘His office is in the building next door.’