The cathedral murders, p.9
The Cathedral Murders, page 9
“Radiology, sir.”
Everybody but Raul laughed. The young student looked confused.
“That makes our differential diagnosis a little more complicated. Although tuberculosis can present with any kind of pulmonary abnormalities on chest X-ray, we are not seeing the characteristic upper-lobe lung infiltrates with or without cavitation. We also don’t see any masses that would make lung cancer less likely. With one exception. Anybody?”
Nobody attempted to answer.
“There is a type of lung cancer called bronchoalveolar cell carcinoma that can present with alveolar infiltrates and look just like pneumonia.”
The team members looked at each other, disappointed.
“Let’s see if we can get some help from the lab results. Anything significant?” Casals asked again.
“White blood count slightly low, 4,000. Hemoglobin slightly low, 11.5. Creatinine slightly high, 1.6. The urinalysis showed 3+ red blood cells, 3+ protein, no bacteria. Blood and urine cultures are negative.”
“Hmm, interesting.” Casals rubbed his chin. “The renal function is not normal and the urine has blood and protein. I guess the next question is: are those renal abnormalities related to the pulmonary picture at all, or are they two different, not related things?”
“Maybe they are two different things,” Hugo said. “The renal failure might be acute if our guy was a little dehydrated. And maybe he has some blood in the urine from an enlarged prostate.”
“Yes, those are possible explanations, but the presence of 3+ protein suggests kidney involvement at the glomerular level.”
Nobody said anything. They knew Casals was getting ready to say something brilliant.
“Remember this,” he said. “When you approach a difficult-to-diagnose case with multiple manifestations, always try to apply Occam’s razor.”
They looked at each other confused. What did he just say?
“Generally speaking, Occam’s razor says that the most likely explanation is usually the most simple one. The way it applies to our field is trying to explain that all the signs and symptoms are being caused by one single illness rather than multiple ones.”
Never heard of it.
“Going back to our case, what condition could explain pulmonary involvement causing hemoptysis and kidney involvement causing increased blood and protein in the urine?
Everybody remained silent. And then it just came to his mind. “A vasculitis,” said Guillermo victoriously.
“Exactly. Vasculitis refers to conditions that can affect and cause inflammation in multiple organs.”
“Can you guys name any vasculitis that causes pulmonary and renal involvement?”
“Wegener?” asked Hugo.
“Very good. These are uncommon conditions, but mostly remember Wegener granulomatosis and Goodpasture syndrome. Ideally you want a biopsy to make the diagnosis. But let’s start ordering serologic studies first. Let’s also consult pulmonary. I tried not to consult too many specialties, since I want you guys to come out with your own differential diagnosis and plan but in this case, we will probably need a bronchoscopy.”
Hugo had finally made a fortunate intervention and could not hide a triumphant smile.
Stop smiling, jerk. I said vasculitis first.
“Okay guys, let’s take a break for lunch. Page me if you have any questions,” Casals said.
“Those were some of the best teaching rounds ever.” Guillermo could not hide his admiration for the attending.
“I agree completely,” Isabella said.
“I guess I’m gonna have to read about Occam’s razor.”
“Hey Guillermo, I wanted to ask you something,” Isabella said as they both walked outside the unit. “Have you ever seen the guy that works in the morgue?”
“Are you talking about Igor?”
“Igor? Is that his name? Seriously?”
“No, I don’t actually know his real name, but everybody calls him Igor. I picture him like a dungeon guard. What’s up with him?”
“He acted kind of weird when I went to see Mrs. Jimenez’ body, and I caught him staring at me the other day. I had the impression he was following me.”
“Well, I guess he could just find you attractive.”
She blushed and looked down. “Whatever. He freaks me out!”
He realized that the compliment had made her feel uncomfortable and tried to quickly change direction.
“You think he’s somehow related to these killings?”
“That’s what I’m wondering. Can you maybe ask other people if he is known for any unusual habits?”
“His looks are unusual for sure,” he said casually.
Isabella didn’t reply. She just looked at him with cold eyes. She was obviously taking this matter very seriously.
“Of course, I will.”
35
Captain Raymundo Vidal was tired of dealing with the frequent power failures at the DINCOTE’s old building. Not enough natural light reached his corner office, and if the electricity was not back soon he was going to have to bring unfinished work home with him. Something he really hated.
“Sorry to interrupt, Captain.” The young officer opened the door shyly.
“It’s fine. Come on in, Ramirez.”
“The intelligence team doesn’t have enough field agents so I’ve been helping out like we spoke. I’ve been doing surveillance on the ballet dancer’s house.”
“The house in Surco, yes, I remember. What’s happening?”
“Nothing really suspicious. She lives with her fiancé and teaches dance classes to little girls on the first floor.”
“Nothing out of the ordinary?”
“The house appears to produce more garbage than you would expect for two people. So, they’ve been told to examine the trash for clues.”
“Examine the trash! Really?”
“Yes, look for any documents or receipts, but especially look for medications or prescriptions.”
“Interesting. Such an unusual method.” Vidal’s eyes narrowed. Maybe it was time to go talk to them.
36
“I don’t even know why I keep watching the news anymore. One of these days they’re gonna give me a heart attack!” said Archbishop Villena-Alarcon as he got up from his cozy chair to turn the TV off.
“What’s wrong, Father?” asked the young man.
“Same old, Armando. The frequent appearances of the unruly Bishop of Ayacucho on national television are making me upset.”
“Are you talking about Father Silvestri?”
“Of course, Armando! Same freaking Silvestri! I’m getting tired of him.”
The priest washed his hands. He looked at the mirror in front of him. The puffy bags under his eyes were getting more noticeable every day.
“You know what he said this time? He compared Abimael Guzman, the leader of Shining Path, to Pol Pot.” He sat back on his chair shaking his head in discontent.
Armando gave him a perplexed look.
“Do you know who Pol Pot is?”
“No Father, I’m sorry, I don’t”
“How old are you anyway?” the priest asked with a frown. “Sorry, I can’t remember.”
“Sixteen, Father.”
“Well, I think schools should spend more time talking about contemporary world history. Anyway, Pol Pot was the head of a communist party in Cambodia called Khmer Rouge that was in control of the country in the seventies. The Khmer Rouge government was brutal, leading to the genocide of almost two million people. I’m sure Guzman’s going to be very happy with the comparison. He probably loves to get this much attention from the press. At the same time this can only cause more anxiety and fear on the part of the Peruvian people, who are already emotionally overwhelmed.”
“What are you going to do, Father?”
“You know, Armando, I’ve been advised not to do anything, but I don’t think I can continue doing nothing for much longer.”
“Monsignor?”
“Tell me, Armando.”
“Excuse me, Monsignor but your dinner’s gonna get cold,” he said, while pointing at the food tray on the table.
37
Most people would agree that the colorful gardens of Santa Maria Hospital look beautiful during the day, but as the sun goes down, the tall bushes block all the light on the narrow walkways that connect the medical pavilions with the surrounding buildings.
The moon is hiding tonight. Nobody can see anything with this darkness. A perfect night.
A tall shadow wearing a white lab coat opened the door of Pavilion 5, the surgical ward. He had timed himself, waiting for the two floor nurses to get busy attending a new patient that was just brought after undergoing emergency surgery. As always, he methodically went through the checklist on his mind to be sure everything was in order. The Stranger stopped in front of bed 14. A middle-aged woman appeared to be sleeping, but her face did not show signs of being comfortable. Despite multiple abdominal surgeries, the doctors have not been able to eradicate the ongoing infection. She has not been able to eat for weeks and she had to be fed with intravenous nutrition. Constant pain was difficult to treat and the attending had no problems in using a limited amount of morphine otherwise rarely used due to tight hospital regulations.
The Stranger put on a pair of surgical gloves and grabbed two syringes from his fanny pack. The first dose will make you sleep, my dear. The second one will stop your breathing. You will feel nothing, I promise. Then he put the headphones on and pressed play on his Walkman. He closed his eyes as he pushed the drugs in and took a long deep breath.
“I am the eggman, They are the eggman, I am the walrus.”
He watched calmly as the woman’s breathing slowed down gradually and finally stopped. Then he proceeded to leave his personal mark on the patient’s upper chest, next to the central IV line providing parenteral nutrition.
He looked around to be sure nobody was watching and left the building into the blackness of the night.
A perfect night indeed.
38
“Have a good night Dr. Casals!”
“Have a good night Mrs. Consuelo. I’ll be leaving soon, too,” he told the receptionist.
Casals had just finished seeing the last patient of the day and needed a few minutes to complete his notes. He could not stop feeling uneasy, however.
He kept thinking about his meeting with Cazorla. In a way his old colleague was right. Between the hospital and his office practice, he was barely able to afford to pay the rent and living expenses for his family. His wife was a stay-at-home Mom and their two daughters were not old enough to go to school yet. Is working for a drug company such a bad thing? Would I be selling my soul to the devil? Am I being too naive for trying to keep the practice of medicine as pure as possible? He knew that as his daughters grew up, a higher-income job would be needed in the future.
That wasn’t the only thing on his mind, though. When Isabella came to talk to him earlier that day, he had said not to worry about things, when in fact he knew that some patients were dying at the hospital in suspicious ways and only his loyalty to Cazorla and the school was making him keep his mouth shut. He had agreed to wait for a reasonable period, but if more deaths occur he may have to reach the police. I hope Cazorla figures things out soon.
39
The Cathedral of Lima, the most important Catholic building in Peru, stands majestic with its two towers and three large doorways in the historic main square known as Plaza de Armas along with the Municipal Palace and the Presidential Government Palace.
Bishop Juan Carlos Silvestri stood for a few seconds in front of the tomb of the city founder, Francisco Pizarro. The Spanish conquistador died after being stabbed in the throat in 1541, but his actual remains were not discovered until 1977 and placed into a glass coffin inside the Cathedral for display. Silvestri then walked down the aisles as he contemplated the magnificent works of art. To the left of the main altar, he found the seventeenth-century wooden statue of Saint Augustine.
Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee. Augustine’s quote played in his mind almost like a reflex. It was a good sign, he thought, when he saw a familiar figure approaching him.
“Your excellency,” Silvestri said as he leant forward and kissed the Archbishop’s gold ring with the traditional violet amethyst.
“Good morning, Father Silvestri. I appreciate you meeting with me today. Please follow me this way.”
Silvestri hadn’t seen the Archbishop for over a year. Although he might have gained a few pounds, the bearded old priest still looked robust and highly energetic.
In a way the Cathedral was a neutral field. Silvestri would not have been comfortable going to the Archdiocese, where formal audiences would take place. This was a private meeting. No other clergy members were going to be present.
“I love coming to Lima’s Cathedral,” Silvestri said. “A few years ago, the symphonic orchestra performed Mozart’s requiem and it was fantastic. The acoustics of this place are perfect. Maybe we should do those types of concerts more often.”
“Maybe we should. This way, please.” The Archbishop pointed to the stairs that lead to an underground site right underneath the Major Altar. The sign over the door said Cripta Arzobispal. The crypt where Peruvian archbishops have found their final resting place since the mid-1600s.
“Interesting place for a meeting,” Silvestri said without hiding some irony in his voice.
“Nobody will interrupt us here. Please have a seat.” The Archbishop pointed at a small table with two chairs, in the middle of the room. The walls were white and of a rough unfinished surface with the tombstones of the most distinguished men of the history of the Peruvian Catholic Church. Silvestri thought for a second how ironic it would be, if his endeavor was successful today, the Archbishop would most likely never be buried here.
“Let me tell you, Monsignor, that I have always been a big admirer of yours. You are really a role model for all our priesthood.”
“Thank you.”
Silvestri knew that the Archbishop would not respond in a welcoming way from the beginning. Still, he continued with his script as planned.
“You know, I think we share a lot of things in common, Father. We both have similar backgrounds. We both were born in Lima, and did our university studies in Spain.”
“We have a fundamentally different view on how our government is handling the fight against Shining Path,” said the older priest, probably trying not to appear too friendly.
“I think we need to support our government. Defeating terrorism is a complex matter and I would rather leave that to the experts on the field.”
“Interesting viewpoint. Did you learn that from Father Josef Andriso?”
Silvestri smiled, trying to hide his surprise. The old bastard knows about Andriso. He rested his elbows on the table and placed his hands over his mouth to hide the involuntary lower lip twitch. The old man had obviously done his research. Father Andriso was not really known outside his small academic circle. Maybe he had underestimated him.
“Like I said, we need to be supportive of our government,” he said, trying to regain composure, prior to attempting his final argument.
“We cannot close our eyes and choose to ignore flagrant human rights violations.”
“Monsignor, everybody is tired of this war that has been going on for years. We both have the same goal. You are the head of the Peruvian Catholic Church. Tell me what I can do to help you, Father. What do you want me to do?”
Silvestri knew that at this point the old priest was going to think he had easily achieved victory.
“For a start, I would like you to publicly express your concerns regarding human rights violations by the armed forces and that you and your order fully support the Archbishop’s stance on this matter.”
“That shouldn’t be a problem, Monsignor.”
“Is that right?”
“Absolutely.”
“Well then... next, I would…”
“Excuse me for a second, Monsignor.”
“What is it?”
“In exchange, I would like to ask you for something. As a sign of good faith.”
“What is it?”
“I have a letter with me signed by Cardinal Joseph Ratzinger in which he understands that because of your old age and health concerns…”
“I don’t have any health concerns. What are you talking about?”
“...Rome is going to accept your resignation from your extremely stressful position and immediately proceed with the transfer of your services to the Archdiocese of Benevento, where you will continue working as an auxiliary Bishop at the Cattedrale di Santa Maria Assunta.”
The Archbishop shook his head in disbelief while still sitting on his chair speechless, as he probably realized that he had been led into a trap.
“And one more thing,” Silvestri added. “Armando, the young seminarian that lives in your diocese, should immediately be reassigned to another church.”
Villena-Alarcon’s face turned red. For a second, he just stayed there without saying anything. Suddenly he got up and slammed his fist on the table violently. “How dare you! You fucking son of a bitch. You and your fucking Opus Dei Mafiosi, you think you can do anything! You need get the fuck out of here now!”
“I’m very sorry I have upset you Monsignor,” Silvestri said sincerely. Although he had overpowered his opponent, he had also hoped for a different outcome. “I will leave immediately!”
As he walked out the crypt, he saw the Papal Crest with the Latin inscription Ut Cognoscant Te. “That they may know you.” Taken from the Gospel of St. John: “And this is eternal life: for men to know You, the only true God, and to know Jesus Christ, whom You have sent.”
