Blocking thoughts of Ryan and coyotes, I emptied the body bag onto my table. In recent days I'd processed dozens of severed limbs and appendages, and the foot no longer seemed macabre. In fact, the frequency of lower leg and ankle trauma was so high it had been discussed at that morning's meeting. The pathologists and anthropologists agreed that the injury pattern was disturbing.

There is little one can say from eyebaling a foot. This one had thickened yelow nails, a large bunion, and lateral displacement of the big toe, indicating an older adult. The size suggested female gender. Though the skin was the color of toast, I knew this meant nothing since even short-term exposure can bleach or darken flesh.

I popped the X rays onto a light box. Unlike many of the films I'd viewed, these revealed no foreign objects embedded in the foot. I noted that on a form in the disaster victim packet.

The cortical bone was thin, and I could see remodeling at many of the phalangeal joints.

O.K. The lady was old. Arthritis and bone loss fit with the bunion.

Then I got my first surprise. The X ray showed tiny white clouds floating among the toe bones, and scooped-out lesions at the margins of the first and second metatarso-phalangeal joints. I recognized the symptoms immediately.

Gout results from inadequate uric acid metabolism, leading to the deposition of urate crystals, particularly in the hands and feet. Nodules form adjacent to joints, and, in chronic cases, the underlying bone is eroded. The condition is not life-threatening, but those affected experience intermittent periods of pain and sweling. Gout is relatively common, with 90 percent of al cases occurring in men.

So why was I seeing it in a female?

I returned to the table, picked up a scalpel, and got my second surprise.

Though refrigeration can cause drying and shrinkage, the foot looked different from the remains I'd been seeing. Even in the charred bodies and body parts I'd examined, the deep tissue remained firm and red. But the flesh inside the foot was soupy and discolored, as though something had accelerated its rate of decomposition. I made a note, planning to seek other opinions.

Using my scalpel, I teased back muscle and tendon until I could position my calipers directly against the largest bone, the calcaneus. I measured its length and breadth, then the length of a metatarsal, and jotted the figures onto a form in the disaster victim packet, and onto a page in a spiral pad.

Stripping off my gloves, I washed, then took the tablet to my laptop in the staff lounge. I caled up a program caled Fordisc 2.0, entered the data, and asked for a discriminant function analysis using the two calcaneal measurements.