“It’s almost impossible to identify a specific source,” said Moore. “Catgut suture’s manufactured by a dozen different companies, most of them in Asia. It’s still used in a number of foreign hospitals.”

“Only foreign hospitals?”

Tierney said, “There are now better alternatives. Catgut doesn’t have the strength or durability of synthetic sutures. I doubt many surgeons in the U.S. are currently using it.”

“Why would our unsub use it at all?”

“To maintain his visual field. To control the bleeding long enough so he can see what he’s doing. Our unsub is a very neat man.”

Rizzoli pulled her hand from the wound. In her gloved palm was cupped a tiny clot of blood, like a bright red bead. “How skillful is he? Are we dealing with a doctor? Or a butcher?”

“Clearly he has anatomical knowledge,” said Tierney. “I have no doubt he’s done this before.”

Moore took a step backward from the table, recoiling from the thought of what Elena Ortiz must have suffered, yet unable to keep the images at bay. The aftermath lay right in front of him, staring with open eyes.

He turned, startled, as instruments clattered on the metal tray. The morgue attendant had pushed the tray next to Dr. Tierney, in preparation for the Y-incision. Now the attendant leaned forward and stared into the abdominal wound.

“So what happens to it?” he asked. “Once he whacks out the uterus, what does he do with it?”

“We don’t know,” said Tierney. “The organs have never been found.”

Two

Moore stood on the sidewalk in the South End neighborhood where Elena Ortiz had died. Once this had been a street of tired rooming houses, a shabby backwater neighborhood separated by railroad tracks from the more desirable northern half of Boston. But a growing city is a ravening creature, always in search of new land, and railroad tracks are no barrier to the hungry gaze of developers. A new generation of Bostonians had discovered the South End, and the old rooming houses were gradually being converted to apartment buildings.