“We don’t have time for formalities. Not with Jim up there. And besides—I don’t even know how we’re going to explain his death in the first place. Any way you look at it, I murdered this man. My own patient.”

“In self-defense.”

“I know that. You know that. But I certainly don’t have the time to waste explaining that to the police.”

He took the large scalpel and drew it down Redfern’s chest, making the Y incision from the left and right collarbones down on two diagonals to the top of the sternum, then straight down the center line of the trunk, over the abdomen to the pubis bone. He then peeled back the skin and underlying muscles, exposing the rib cage and the abdominal apron. He didn’t have time to perform a full medical autopsy. But he did need to confirm some things that had shown up on Redfern’s incomplete MRI.

He used a soft rubber hose to wash away the white, bloodlike leakage and viewed the major organs beneath the rib cage. The chest cavity was a mess, cluttered with gross black masses fed by spindly feeders, veinlike offshoots attached to the pilot’s shriveled organs.

“Good God,” said Nora.

Eph studied the growths through the ribs. “It’s taken him over. Look at the heart.”

It was misshapen, shrunken. The arterial structure had been altered also, the circulatory system grown more simplified, the arteries themselves covered over with a dark, cancerous blight.

Nora said, “Impossible. We’re only thirty-six hours out from the plane landing.”

Eph flayed Redfern’s neck then, exposing his throat. The new construct was rooted in the midneck, grown out of the vestibular folds. The protuberance that apparently acted as a stinger lay in its retracted state. It connected straight into the trachea, in fact fusing with it, much like a cancerous growth. Eph elected not to anatomize further just yet, hoping instead to remove the muscle or organ or whatever it was in its entirety at a later time, to study it whole and determine its function.

Eph’s phone rang then. He turned so that Nora could pull it from his pocket with her clean gloves. “It’s the chief medical examiner’s office,” she said, reading the display. She answered it for him, and after listening for a few moments, told the caller, “We’ll be right there.”

Office of the Chief Medical Examiner, Manhattan

DIRECTOR BARNES ARRIVED at the OCME at Thirtieth and First at the same time as Eph and Nora. He stepped from his car, unmistakable in his goatee and navy-style uniform. The intersection was jammed with police cars and TV news crews set up outside the turquoise front of the morgue building.