The Autopsy of Esther Marshall
Death is not a pretty thing. It stinks, leaks, oozes, writhes, and stains. Those that deal in death know well the unsightly aspects of what ends up covered in make-up and fine perfumes, or burnt to ash and hidden away in a finely decorated jar. They have a sense of distance about them mistaken for coldness, though in Dr. Hess’ case, that coldness is very much present. As the attending coroner, it is her job to read the bones and guts like ancient wise women predicting a husband or the summer rains, though her gaze is set firmly on the past.
No, death is not a pretty thing, but the young woman on her table this afternoon makes her consider an exception.
The late Esther Marshall could not have been more than 21 years old when she died, survived by her husband Joshua, and infant son, Benjamin Jay. She is the picture of traditional beauty even in death; long blonde hair perfectly straight and trimmed, a pale complexion free of blemishes, and a full figure expected of a new mother though still petite.
“Beginning the Autopsy of Esther Marshall,” Dr. Hess says into the microphone on her coat lapel. “Attending coroner is Dr. Margaret Hess.” She washes her hands, places a dab of peppermint oil on the inside of her mask, and covers her arms in blue nylon gloves. “Mrs. Marshall was found dead in her parents’ home on October 8th, 2022, at 7:34 am. Time of death estimated at the scene as 2:00 am though yet to be confirmed.
She verbalizes the rest of the terms required by law. All findings will be recorded and used as evidence in case charges are pressed, etc.
“This is certainly a bizarre case,” she muses while making sure her tools are arranged to her liking. The other coroners who worked in this space were far too lackadaisical with where they left them. “The parents, particularly the father, objected quite loudly to the performance of an autopsy due to religious objections. The family is devout Fundamentalist Christian, and believe that destruction or tampering with the body will prevent the deceased from attaining heaven.”
Dr. Hess rolls her eyes. These kinds of people always preach forgiveness, yet damn anyone who behaves outside of their narrow margins. Hypocrites.
“In any case, the local authorities mandated an autopsy be performed since this is a case of suspected foul play. Suicide has not been ruled out, although preliminary interrogations have not revealed any ideation known by her husband or close relatives.”
They could, of course, be lying.
That’s what her job is after all. Let the one who suffered most tell the story, not the living.
Dr. Hess patrols the body with a powerful camera for preliminary images. From what she can see on the outside, it’s as if she simply died in her sleep. Here one minute and gone the next. She notes this in her verbal records, followed abruptly by a contradiction.
“Mrs. Marshall was found on the kitchen floor of her father’s house in Joshua County. Mr. Dower’s home was subsequently searched by first responders, though predictably, they failed to turn up any evidence. She was visiting her family for the weekend according to testimonies from her father, mother, and thirteen siblings.”
The words leave bitterness in her mouth, but she keeps her thoughts and memories to herself. It is not professional to interject unrelated notes in a legal recording; something she wishes her coworkers would remember.
She begins her external examination with a short note to her recorder. First, she manipulates Mrs. Marshall’s neck, turning it right then left, rotating it, and then bending it as far forward and back as she can. Aside from the stiffness of rigor mortis, it moves smoothly. Her thin fingers press against the girl’s clavicle, sternum, and each individual rib. Nothing moves that shouldn’t. She traces the stretch marks of recent pregnancy, notes the blemishes, and then tests her legs and pelvis. There is the telltale trauma of birth between her legs, however, this is the only outward appearance of harm to the girl’s body.
Dr. Hess notes the lines of differing pigmentation on her hands, face, and feet. Everything past the lines is milky, pale white while the few parts that would have been exposed to the sun carry the redness of a hot summer’s day.
“Unremarkable anterior features,” she says. “Beginning examination of external posterior.”
With some effort (her assistant caught a bad case of COVID-19, otherwise it would be easier) she flips Mrs. Marshall over so that she lies face down on the cool examination table.
Oh, now this is interesting.
A tattoo, something that would never have been approved by her parents or faith, is perched right above her buttocks. It’s a simple, inoffensive design; a pink and black butterfly with a basic pattern on its right and left. Any young adult woman would have something like this. Dr. Hess herself considered one in her youth. However, a tattoo to a Fundamentalist Christian such as Mrs. Marshall would be a monstrous sin. Their bodies were considered temples after all.
The deceased was a hidden rebel. Possible cause of stress within the family, she muses to herself as she takes pictures. “The wounds are well healed now, but there is some evidence of scarring.” Perhaps she couldn’t take proper care of it without exposing herself. She snickers to herself; perhaps she also dared to wear pants.
The evidence of rebellion continues on the back of her neck, just below the hairline. Her skin is stained black, but only faint traces remain of what must have been a cheap dye. It’s certainly a more outward act than a hidden tattoo, considering her striking blonde hair. Dr. Hess does not know much about the husband, but it’s possible that he acted as a catalyst for his wife to experiment with herself. Her limited knowledge of psychology is enough to know that the lack of identity development in childhood manifests itself in interesting ways in adulthood, particularly in these overzealous religious groups. Dr. Hess’ own childhood wasn’t much different, however, she rebelled by immersing herself in science over superstition. Somehow, she finds herself envious of the dead girl and her bravery.
After turning Mrs. Marshall over once again, a long needle connected to a length of surgical tubing is brought up from the tray of devices. Dr. Hess angles the tip to where the deceased left breast meets her chest and pierces the skin. It sinks deep into the chest cavity until the needle is fully embedded in her body. A button is pressed; an LED display lights up and beeps within seconds.
“37 degrees Fahrenheit internal temperature. The body has been contaminated by cold storage. As previously stated, the family of the deceased made efforts to prevent an autopsy from being performed.”
After taking aside a sample of thick, tar-like blood for toxicology labs, she grabs her scalpel and extra blades when she notices something on the girl’s chin. Upon further examination, there appears to be a thin sheen of sweat or saliva that trails from her mouth down to a part of her neck. It’s faintly yellow, or green, it’s hard to tell in the light.
“Vomit stains near the mouth and jawline. Someone tried to clean them away with harsh chemicals, as evident by the faint acidic abrasions on her lips.”
How did she miss this in her initial exam? The face and throat were some of the very first things she was supposed to check. Perhaps she is tired. She takes a short break to gather her thoughts and reexamines the head. Her fingers feel the throat and face for anything unusual. Of course, she finds nothing, how could she doubt herself like that? Just to be safe she reexamines the skull and-
“Small lumps on the skull, beneath the scalp. Pliability suggests scar tissue from childhood injuries.”
Satisfied with her discoveries, she begins to prepare the body for internal examination. With practiced hands and expert precision, Dr. Hess draws her blade down the clavicle and stops at the top of the breasts, then again on the opposite side. From the connected incision, she cuts straight down Mrs. Marshall’s belly and ends at her pelvis. The skin parts without resistance against the razor’s edge, peeling away to reveal the fascia and fat that cling to structure even in death. Another series of cuts sloughs away yellow globules of fat, some of which need to be scooped out and placed in a disposal bag by the handful. Her abdominal cavity opens after a third cut and she braces for the rush of foul gasses that never arrives. Right, cold storage slows decomposition. She shakes her head, maybe she needs to take a break. Or maybe not; stopping in the middle of the procedure would only slow her progress. Her own discomfort is superficial.
There are some discolored splotches in the sheaf of skin that catch the coroner’s attention. “Old contusions and bruises on subdermal layers. They appear to be at least,” she squints and rubs her gloved thumb over one of the spots, “at least ten to fifteen years old.”
Dr. Hess removes the last layer of tissue that protects the thoracic cage. At first glance, all appear within acceptable parameters. That is until she finds a bump on L5. Then one on R4 near the sternum. Then L2, R6, and even the blunted remnants of L11 and R12, the colloquially named “floating ribs”.
She worries the inside of her cheek between her teeth. “Extensive past trauma to the chest. Old fractures have been healed professionally, but the evidence remains.”
A notice in the case file alerted her to what the family claimed was a “traumatic ATV crash”, but what’s presented to her now doesn’t line up with what she’s been told. All fractures should be on one side, with cartilage damaged as well. The sternum should be splintered or held together with screws and staples. These seem more in line with repeated blunt-force injuries than with a single crash.
Photographs are taken and findings are recorded. Dr. Hess speculates and posits to herself and her future reviewers. It could be the husband, she thinks as she retrieves her thoracic spreaders, a grim set of devices that break and separate the ribcage. It’s usually always the husband in these cases. But these are old, too old for it to be the work of the devoted spouse met just days before their wedding.
So then, who?
As she places the jaws of her tool against the first bit of cartilage, she wonders aloud after turning off her recording device.
CRACK
“At this stage, I believe there to be an unknown person in her life.”
CRACK
“Perhaps someone she met on the job, or someone in her family though not close or blood related.”
CR-CRACK
“An in-law perhaps.”
CRACK
“Or a third cousin.”
CRUNCH
“Someone she trusted who could have had access to her at a young age, unsupervised.”
CRACK
“She clearly rebelled against her family and faith, so it’s possible she might have found a like-minded individual in her parish.”
CRACK
“And once trust was established-”
CR-CRACK
“They would have taken advantage of her.”
CRACK
“All the way into adulthood.”
This is the most intensive part of the process, aside from removing the skin. It takes her another five minutes of silence, apart from the grim snapping of bones and cartilage, to detach them. The entire structure from sternum to clavicle is removed in one piece, albeit with a few swipes of her scalpel to disconnect a few white strands of facia. With the chest cavity exposed, Dr. Hess works to open the abdominal cavity as well. It’s not proper in the order of autopsy, but it saves time.
Striking black lungs gaze out from the inside, damning the dead girl once again in the eyes of her faith. Dr. Hess records this in voice and photography, noting that for this kind of damage to occur in someone this young, she would have had to start smoking at age 13.
She turns the recording device back on. “This is not consistent with examples of damage from secondhand smoke. The damage is so extensive I believe she must have been secretly smoking infrequently since childhood.”
She removes the lungs, filthy things heavy with tar and brittle enough to damage from touch alone. The question of tobacco or marijuana, or both, would be a question for the toxicology team. A sample is scraped away and confined to a tube.
The heart is, admittedly, undamaged. The coroner finds strain and wear that is normal for the process of death, possibly even heart failure, though the two overlap often enough for it to be overlooked. In this case, she leans towards the latter. Similarly to the lungs, the liver is more akin to that of a 40-year-old, lifelong alcoholic. The dull brown flesh is covered in viscous scaring and irregular lumps, iconic signs of advanced cirrhosis.
While collecting samples for toxicology yet again, and photographing the organs both in and out of the cadaver, Dr. Hess notices something. Removing the pink coiling serpentine intestines reveals the cause of the strange hump in her abdominal cavity.
“Forgive my break from the order, but I have noticed strange inflammation in the uterus.”
In fact, there’s far more than just simple inflammation. The uterus is a sturdy organ, able to stretch to fourteen times its size and retract again. It’s miraculous, but even miracles carry the scars of time and trauma. The recent tearing and misshaping of the organ is one thing, but the deep, faded stretchmarks and scars show far more than any report ever could. However, there’s something wrong here. The elasticity of the uterus itself is far too relaxed for someone’s first pregnancy. It’s more consistent with someone who has been pregnant at least three or four times. The distended abdominal cavity tells the story of someone who has had more children, and started from a very young age.
“This is much more damage than a normal, healthy pregnancy should entail. I wonder if the husband’s testimony of the birth was accurate-”
She prods the uterus with her thumb and feels something hard within.
“Hold on…”
Dr. Hess removes the uterus and takes it over to her smaller tray. She carves into the flesh, a solid wall of thick, corded muscle designed to nurture and defend life. Sure enough-
She sets her scalpel down and clears her throat.”
“Mrs. Marshall was several months pregnant at the time of death. Samples will be collected and sent to DNA testing.”
Dr. Hess grew up in a family not too dissimilar to Esther’s. Oppressive parents restrict everything about their child’s life in the name of purity and modesty, faith-based fearmongering, and the ever-present specter of hell threatening to swallow up anything that doesn’t fall into the strict doctrine of their god. Life is something that is sacred, to be cherished and celebrated, and most importantly, announced or mourned. Mr. Marshall, according to all of his testimonies, never once indicated that his wife was pregnant.
He did, however, indicate that in the months leading up to her death, she became more fearful. Of what, he could never tell. She would never tell. However, he mentioned, in an offhanded, off-the-record remark, that she was looking for any excuse possible to avoid visiting her childhood home. In particular, she was trying to hide her fear of seeing her father again.
She takes a deep breath, cooled by the scent of peppermint, and turns her attention to the stomach. Without the liver to nestle into the organ sags into the abdominal cavity, without support it loses its shape. It molds to the shape of her hands, defying rigor mortis. The pale hue of bloodless muscle and dried mucus shimmers in the overhead fluorescents as she sets it on the icy examination table.
The scalpel blade slices through the thick muscle wall of the stomach, from end to end. Leftover stagnant bile seeps from the split lump in the organ’s center, yellow and runny. Dr. Hess peels open the lining like an ancient tome.
“Pills,” she breathes into the microphone on her lapel.
At least a dozen undigested, translucent blue capsules sit amongst a puddle of their dissolved brethren. The distinctive red tint of wine colors the lining around them. It’s impossible to tell how many were actually ingested. She silently takes samples for the labs, but she doesn’t need to see the results to know this combination with harrowing certainty.
The esophagus shows bruising, recent trauma, and peristaltic strain along with acid burns. Strips of foreign skin are wedged in between her teeth. She tried to fight.
“There’s no question,” Dr. Hess says in a cold voice laden with venom. “Mrs. Marshall was murdered.”
A murder staged to look like a suicide or a murder that attempted to be painless. Unfortunately for Esther, there is no such thing as a painless death. The body fights against its own demise; it expels poisons, knits flesh together, and even blood is designed to stop unnecessary loss. The body fights tooth and nail, it screams against its fate just as this girl surely did.
Dr. Hess touches Esther’s wrist, but jolts when she feels something she had missed in her initial examination.
On both of the wrists are two faint vertical scars; they are clumsy and ragged, not deep enough to kill but the intent is clear. These kinds of scars mean death, they’ve indicated a last act of despair and hopelessness. But these are old scars, too old to have contributed to her death. The concealer that hid them from the outside world rubs off on nylon gloves. A last act indeed. The last chance to exert some kind of autonomy over oneself.
The pieces fall together in her mind, though she’d need to investigate further. The fear of the father, the pills shoved down her throat, the alcohol in her stomach, and a pregnancy consistent with the stay at her parent’s house. A horrible childhood that pushed her towards her own destruction, but it wasn’t the sinful acts that doomed her. In the end, it was her own “umbrella of protection” that caused her so much pain and suffering. The same umbrella that placed a brand on Dr. Hess’ back defiled this poor girl again and again until she felt that she needed to escape life altogether. Not even marriage could save her from the ever-present horrors of her life.
“We don’t need to wait for toxicology or DNA results to return,” the coroner says as she begins to sew Esther Marshall back up. “We all know what’s happened here.”
© Sarah Blackford
Sarah Blackford is a student at UMBC studying art history and creative writing. She aspires to create strange and macabre stories of various subject matter.
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