PROFESSOR GORSHKOV LAID BARE.
Monday the 23rd
I spent the following morning giving evidence at coroner’s court. It was an open and shut case of suicide by strangulation. What made it somewhat irregular was that the victim had placed a noose around his neck, then succeeded in lassoing the ten forty train to Ipswich.
“A very poor choice,” lamented my housemate when I related the story to him later that evening. “The eleven fifteen to Brighton is a far superior selection. In some stretches, the scenery is quite breathtaking.”
“I’ll be sure to pass your comments to the coroner, Fairfax. As a matter of fact, I was surprised that you didn’t take an interest in the case.”
“It is my frank experience that in cases of suicide by public transport, one will often wait for what feels like an eternity for such a case to arise, only to have several come about at precisely the same moment.”
“Isn’t it always the way? Oh, I almost forgot, I managed to obtain Professor Gorshkov’s autopsy report.”
“Capital fellow. May I take a look?”
Urban-Smith’s instinct to review the autopsy report had been a sound one. The cause of death was not as simple as I had first believed. I have reproduced the salient features of said report, with my annotations in brackets. The full report can be accessed HERE.
“These are the findings of a post-mortem examination carried out at 10 A.M on Tuesday, the 10th October, 2006 on the body of Professor Trofim Gorshkov. Professor Gorshkov is reported to have collapsed suddenly after an epileptic fit on the evening of Friday, the 6th of this month.
Summary of Clinical History.
Professor Gorshkov was a fifty five year old ex-smoker with a past history of type 2 diabetes and hypertension, for which he was taking gliclazide, amlodipine and simvastatin. On the evening of his death, he was witnessed to demonstrate a sudden change in mood, exhibiting marked euphoria. Within a few seconds, he collapsed and entered a brief tonic-clonic phase, before experiencing cardiac arrest. Cardiopulmonary resuscitation was attempted by onlookers, but he was pronounced dead upon arrival to hospital. There was no reported trauma, or ingestion of illicit substances, though the deceased had consumed a moderate amount of alcohol, estimated to be between eight and twelve standard units in the course of the evening.
1 Formal navy suit jacket, with staining upon the lapel
2 White dress shirt
3 Navy trousers
4 Brown leather belt
5 Blue, cotton boxer shorts
6 Navy socks
7 Black, size 9 leather shoes
8 Plain, gold wedding ring upon left 4th finger
9 Digital wristwatch on left wrist
Body is that of a male, with short grey hair and beard. Length is 182 cm, weight is 84kg. There are electrode pads attached to the front of the chest and to each wrist and shin. There is a scar in the right lower abdomen, compatible with previous appendicectomy. There are no tattoos, piercings or other scars or distinguishing features. Appearance is compatible with age.
(Appendicectomy is usually attempted laparascopically these days, so the appendix scar may become a thing of the past. There is no mention of cannulae or endotracheal tube, so I suspect he was thoroughly dead by the time the paramedics arrived.)
There are a few abrasions on the left arm and left side of back, compatible with minor injuries from a collapse. There are no significant external injuries. The body is not jaundiced, or oedematous. There is post mortem lividity on the back, but no rigor mortis.
(The body would have been laid upon the back in the ambulance, Emergency Room, then mortuary. You would not expect any rigor mortis after 36 hours.)
The arrangement of the organs appears normal.
The heart is of normal size and shape, and weighs 315g. There is a mild degree of mitral incompetence, but no other significant valvular disease. The coronary arteries show a moderate degree of atherosclerosis, with a maximum 40% stenosis noted in the right coronary artery. There was no significant coronary artery occlusion.
(Narrowing of the arteries would be expected in an ex-smoker of this age. If anything, I might have expected the arteries to be worse than this.)
There are no tumours or obstructions in the larynx or trachea.
The pleura are unremarkable, with no pleural effusions or adhesions.
The right lung weighs 590 grams, and the left 540 grams. The pleural lung surfaces are dull and when cut, there is loss of parenchyma and numerous areas of alveolar loss and small bullae.
(These changes indicate emphysematous damage to the lungs from previous cigarette smoking.)
The oesophagus is normal with no evidence of ulceration or varices. There is a small hiatus hernia noted, but no associated oesophagitis or stricture. The stomach contains food and liquid, with no evidence of tablets or capsules. The mucosa appears normal, with only some mild antral gastritis, but no ulceration or malignancy.
The large bowel contains a moderate amount of formed stool, with no evidence of tumour or perforation. The appendix is absent. There are several diverticulae in the descending colon.
(Diverticulae are areas of swelling that appear in the wall of the bowel, so that instead of a smooth walled tube, the bowel appears to have bubbles on the surface. This is such a common finding in the older adult, that it can be considered a normal part of the ageing process, along with the mislaying of one’s keys, and the wearing of increasingly capacious underpants despite progressive shrinkage of the contents. This latter phenomenon is known as the Law of Inverse Drawer Proportionality.)
The liver is enlarged and weighs 3420 grams. The cut surface is greasy and pale yellow in colour, indicating steatosis. There is no evidence of progression to hepatitis or cirrhosis.
(A normal liver only weighs half of this. The greasy, pale appearance is due to accumulation of fat inside the liver, as a result of excess alcohol.)
The right kidney weighs 183 grams and the left kidney weighs 160 grams. Each kidney shows normal morphology with no hydronephrosis and a normal calyceal system. The renal pelvices and ureters are unremarkable.
The adrenal glands appear normal and each weighs 5 grams.
The bladder is normal.
The prostate is smoothly enlarged, inkeeping with the deceased’s age. The prostate weighs 35 grams. There are no macroscopically visible areas of malignancy.
(It is not uncommon for the prostate to have small foci of cancer within it, but these may only be apparent on histological examination. Professor Gorshkov’s prostate did not contain any areas of cancer, according to the histology report.)
The left testis weighs 22 grams and the right weighs 18 grams. There are no obvious focal lesions. The penis is uncircumcised.
Head and Neck
The thyroid is normal and weighs 38 grams. There is no cervical lymph node enlargement.
The scalp and skull are unremarkable, with no evidence of trauma. The dura and meninges are normal. The brain and brainstem are markedly oedematous and weighs 1650 grams. There is flattening of the gyri and narrowing of the sulci. There is coning of the cerebellar tonsils.
The ventricles are compressed and the cerebrospinal fluid is clear. Sections through the hemispheres show no mass lesions, infarction or haemorrhage. Sections through the brainstem demonstrate multiple areas of haemorrhage ranging from 1 to 5 millimetres throughout the thalamus and hypothalamus, with some extension into the midbrain and pineal gland. The pons, medulla and cerebellum are largely unaffected, but there is damage to the cerebellum where the inferior aspect has herniated through the foramen magnum.
(The Professor has died as a result of acquiring many small areas of bleeding around the thalamus and hypothalamus, which is located between the cerebral hemispheres and the midbrain. The brain is cushioned and protected via the circulation of a clear fluid, which flows through a system of channels and spaces within the brain and nervous system. Blockage to this system leads to a rise in pressure that causes expansion of the spaces within the brain and can eventually cause the brain to swell within the skull, a condition known as obstructive hydrocephalus.
The interruption of the flow of blood and cerebrospinal fluid (CSF) has resulted in the accumulation of fluid, and the Professor’s brain has become swollen and heavier than normal. The surface of the brain has lost some of its normal folded appearance as it has expanded, the spaces within the brain (the ventricles) have been compressed, and the brain has swollen so much that the lower portion of the brainstem has been forced downwards through the opening at the base of the skull (the foramen magnum). This forcing of the lower brain through this opening is called coning, and results in coma, seizures and death.)
Microscopic Examination and Toxicology
(During an autopsy, samples are taken from each organ for histological analysis, and samples of stomach contents and vitreous humour (the fluid within the eye) are sent for toxicology. I have omitted the histology and toxicology sections, as they hold little interest for the non-medical man, and do not add any new information, save to confirm that the Professor had consumed a moderate amount of alcohol prior to his death. There were no other toxic or illicit substances detected.)
Summary of findings
This 55 year old man died from multiple haemorrhages within the thalamus and hypothalamus, leading to a rapid elevation of intracranial pressure and resulting in tonsillar herniation through the foramen magnum. There is no history or evidence of trauma, therefore the cause of death is recorded as
1a – Cerebral haemorrhage due to
1b – cerebrovascular disease due to
1c – hypertension
contributed to, but not caused by
2 – diabetes mellitus, emphysema and alcoholic liver disease.”
“What do you say, Rupert? Did Professor Gorshkov die from a stroke, or number of strokes?”
“It would appear so, but the pattern of disease is most unusual. The presence of multiple small intracerebral haemorrhages is very reminiscent of traumatic head injury. Perhaps on his journey to and from his hotel room the Professor encountered some misfortune, perhaps a fall down a flight of stairs, or an altercation of some kind?”
“The lack of external injuries would make it highly improbable.” He looked bitterly disappointed. “Based on the available evidence, we have to conclude that he died from natural causes, and that it is indeed purely a matter of coincidence that the death occurred in such a peculiar and public fashion.”
“Based on the evidence, indeed we do,” I concurred.
He stood and began to pace the room. “Then why, dear Rupert, do I share strongly Dr. Grove’s sense of unease about this affair? What was the nature of the phone call that came at the precise moment of Professor Gorshkov’s death? What was it about the Professor’s demeanour prior to his strokes that induced the feelings of dread and trepidation described by the good doctor? And finally, we have the matter of the burglary that took place that very week. Must we believe that these events are unconnected?”
“I did not say that they were unconnected,” said I, “but they do not detract from my conviction that the death was a natural one. It is, for example, entirely possible that the stress of the burglary had caused a rise in the Professor’s alcohol intake, in turn leading to a worsening of his diabetic control, rise in blood pressure and derangement of triglyceride levels. It is perfectly feasible that these changes would prove sufficient to precipitate an acute micro, or macro-vascular event.”
Urban-Smith threw himself back into his armchair. “I don’t like it, Rupert. I feel that we are overlooking something fundamental to this case.”
“What do you propose?”
“We need data. I think we should pay a visit to the Professor’s widow, see what she can add. We need to take a look at his laboratory and his research, and try to establish a motive for the burglary.” He reached for his mobile telephone. “I shall contact Dr. Grove and ask if he can arrange meetings with Mrs Gorshkov and the Dean of the Professor’s faculty.”
“What is the relevance of seeing ghosts?”
He looked at me bemused. “Sorry?”
“You asked Dr. Grove if he had ever seen a ghost. You seemed to place great significance to his affirmation.”
“Indeed I do, for it would appear that Dr. Grove is what is known as a sensitive. There are some among us who are able to detect the presence of energies and stimuli of which the majority are oblivious. I believe that Dr. Grove’s reported sense of fearful dread and foreboding was a barometer of some anomalous atmospheric or psychic phenomenon.”
I scoffed at the suggestion. “Dr. Grove is not a sensitive; he’s a neurotic! For Heaven’s sake, the man is wetter than a herring’s chequebook.”
“Don’t be too hasty, Rupert. There may be more to the man than a brittle spleen”
“Are you a sensitive, Fairfax?”
“Not in the least; I have the sensitivity of a house brick.”
The mantel clock struck eight, and I rose. “If you will excuse me, I must away to my club, as the floorshow starts in less than an hour.”
“Of which club are you a member?”
“The Blue Belvoir, on The Spawn. Do you care to join me?”
“Not for me, thank you, Rupert, as I still value both my liver and my eyesight.”
I spent a couple of very jolly hours at The Blue Belvoir Club, where I made the acquaintance of several vivacious young ladies, and exchanged stimulating conversation with my peers, yet my libations did not convey their usual satisfaction. I was troubled by Urban-Smith’s trepidation, his instincts in such matters being akin to those of Polypheides.
I returned to Chuffnell Mews just before midnight, but sleep did not come easily, and when it did, my dreams were fervent with visions of Dr. Grove gyrating about a polished steel pole, swinging his spleen about his head, while middle-aged revellers tucked pound notes into his garters. I awoke at dawn with a disturbing combination of wry amusement and morbid horror, and dared not go back to sleep.