Page 85 of To Die For

“Didyou find evidence of Narcan in their systems?”

“No, but my examination wouldn’t necessarily reveal it. However, the tox screen would likely show traces of its presence.”

“The reports say that fentanyl is the suspected drug.”

“And as I said, those werenotthe reports I wrote. I would never have inserted a preliminary cause of death like that, particularly when I had found no evidence of it. Fentanyl has the ability to bypass the brain-blood barrier, which makes it ideal for pain management, but terrible for addiction. There’s also a synthetic opioid coming out of Europe, two-benzyl benzimidazole. It was developed in the fifties as a painkiller but was never approved for medical use. It’s up to twenty times more potent than fentanyl.”

“God help us,” muttered Devine.

“The point is, I’ve had to perform, unfortunately, hundreds of autopsies on fentanyl overdose victims, so I know what to look for. And I did not find it with the Odoms.”

“Okay, but did you find evidence ofpoisoning? Is that why you ordered the tox screen? Because you wouldn’t have ordered one based solely on suspected drug overdoses, according to your findings and the protocols you just outlined. There wasn’t any evidence of it.”

She didn’t answer right away. “You’re absolutely right, Agent Devine. I actually suspectedcyanidepoisoning.”

“Like in an Agatha Christie novel? What, did you smell bitter almonds?”

“No, I smelledgarlic, Agent Devine.”

CHAPTER

39

DEVINE GAPED. “GARLIC? AM Imissing something here?”

“Despite being a deadly poison, cyanide is actually naturally occurring. Found in the soil, water, air. Those types are not typically lethal, at least not in unconcentrated doses. It’s also heavily used in various industries, like photography, chemical research, synthetic plastics manufacturing, and jewelry polishing.”

“Okay, so it’s all around us, but how does it actually kill?”

“By preventing cells from using oxygen to make energy molecules. Deprived of that, the heart and nerve cells rapidly shut down. Now, you can inhale it, be injected with it, or absorb it through your skin. Inhalation is the most lethal because it’s the fastest acting. That’s also why people die inhaling smoke in fires. Plastic and other industrial products are full of cyanide. Now,ingestionof a concentrated dose is also bad but it may give time for treatment. The Jonestown mass suicide used cyanide in the Kool-Aid. Other things being equal, poisoning viaadsorptionis probably the most survivable because it’s the slowest acting.”

“What are the symptoms?”

“Immediate ones are headache, dizziness, fatigue, weakness, shortness of breath. Longer exposure results in low blood pressure, convulsions, slow pulse, lung damage, respiratory failure, unconsciousness, coma, and then death, which is almost always by respiratory-cardio failure.”

“What made you suspect it was cyanide?”

“There was no detectable smell of bitter almonds, as you alludedto. But the bitter almond smell is not always present, and here it might have been overwhelmed by the garlic odor I encountered.”

“And wheredoesthe garlic come in?”

“I’m getting there. Bear with me. I noted that both the Odoms’ blood and skin were pink-red, which made me think of cyanide.”

“Why?”

“It shows that the blood was full of oxygen.Toofull. That’s because the cyanide was blocking it from being absorbed into the cells. Because of that, and other factors, I ordered up an in-depth testing and analysis of blood and urine samples using UPLC/MS.”

“You’re going to have to explain that one.”

“Ultra-performance liquid chromatography in tandem with mass spectrometry. It’s a complicated process, but is necessary toconfirmthe presence of cyanide.”

“Okay.”

“Cyanide rapidly disappears from the blood and urine, so the collection of biological specimens has to be done fairly quickly. And the postmortem formation of cyanide in the body can also occur and further complicate matters. All in all, it’s tricky.”

“And thegarlic? Where does that come in?”

“It was a hunch on my part. But I couldn’t see how the Odoms could haveinhaledcyanide at such a level and concentration to kill them, while their daughter was completely unaffected. And there was no corrosion of their esophagus or stomach lining, which you typically see iningestioncases. But when I detected the strong smell of garlic, I thought about something called DMSO.”

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