AT EIGHT THIRTY THE NEXT MORNING RYAN AND I WERE ON our way to MUSC. He looked relaxed for the first time since arriving in Charleston. The night before he'd had another conversation with Lily's mother. Though his daughter still felt angry and hostile toward him, Lily had agreed to speak with a counselor. Lutetia was setting up a series of appointments.

Or maybe it was the sunburn. Or the post-barbecue nooky. Whatever the cause, Ryan seemed much less tense.

Lee Ann Miller met us at the morgue door. After a virtual replay of Ryan's early morning comments concerning the rainbow bruise on my arm, she went to retrieve the barrel lady from the cooler. In her absence, I again tried Nelson Teal. This time the line was engaged.

Possible progress. A busy signal meant someone was home, unless another incoming call was tying up the line.

Having delivered the remains to the autopsy room, Miller took off to do paperwork. Ryan settled in a chair with his Conroy book.

I gloved, then laid out the skeleton. Based on my experience with Cruikshank and Helms, my impulse was to go straight to the vertebrae. Instead, I followed protocol, methodically moving from the head toward the feet, examining each bone under magnification.

The skull showed no signs of violence. The jaw was undamaged. I found nothing on the hands, nothing on the arm or shoulder bones. The sternum and upper cervical vertebrae were intact.

Then everything changed.

"Look at this," I said to Ryan, a cold dread sprouting in my gut.

Ryan squinted into the scope.

"You're looking at the left transverse process of C-6. The fractures are identical to those I found on Helms and Cruikshank. Same vertebra, same side."

"Hyoid broken?" Ryan referred to a U-shaped throat bone that's often fractured during manual strangulation.

"No."

Ryan straightened. "Hanging?"

"The fracturing is limited to one side."

"Sudden wrenching?" Ryan was going through the same mental checklist I'd considered.

"Maybe." I pointed to the vertical hinge fracture on the anterior lamina of the transverse process. "This is where the anterior scalene muscle originates." I moved the tip of my pen to a bony prominence beside the fracture. "This little bump is called the carotid tubercle, because it's the pressure point for the carotid artery. Sudden wrenching could cause compression of the carotid sheath. If compression was severe enough it could cut off blood flow to and from the brain, and that could result in death."

"Half nelson?" Ryan referred to the wrestling hold in which one arm is passed under the opponent's armpit from behind and brought around to the back of the neck.

I raised both palms in frustration. I'd been thinking about this since first seeing the fractures on Willie Helms's vertebra. I still hadn't figured it out.

"I understand the physiology of the injury, it's the mechanism that confuses me. The hinge fracture suggests quite a bit of force was applied. A sufficiently severe back and crosswise wrench of the head against the contraction of the anterior scalene usually tears or loosens the anterior tubercles of the fourth through the sixth vertebrae. So how could so much force be delivered yet only a single bone be broken?"

Ryan delivered a "don't look at me" look, then settled back with his book.

I returned to the bones.

And minutes later found the first nick. L-3. Belly side. Like Helms. The dread expanded into my chest. I continued my examination.

It took less than an hour. When done, I summarized my findings for Ryan, indicating each area of trauma with a pen.

"Hinge fracture on the left transverse process of the C-6 vertebra. A total of eight cut marks on the belly surfaces of lumbar vertebrae two, three, and four. That's it. No other damage to the skeleton."

"Think she was gut-stabbed?" Ryan asked.

"If this is a stabbing, the perp was cranked. The blade would need to have penetrated her entire abdomen to nick the vertebrae on their anterior sides."

"Any idea of tool type?"

"The cuts are tiny, V-shaped in cross section, with clean edges and no striations. All I can say is that it's an implement with a very sharp, nonserrated blade."

"Defense wounds?"

I shook my head. "The hand and lower arm bones are undamaged."

"So Cruikshank had the fractured neck vertebrae, but not the nicks. Helms and Montague had both." I could tell Ryan was thinking out loud.

"Yes. If they were killed by a common killer, they may have been killed for different reasons."

Neither of us came up with a good explanation. But Ryan's earlier comment had tickled a memory. Years back a colleague had reported on unilateral midneck fractures. Who? And where? Was it a presentation at a professional meeting? A published article? In what journal?

I needed to get online.

Driving back to Isle of Palms, I again called Nelson Teal. This time a woman answered. I introduced myself and explained my reason for phoning. The woman gave her name as Mona Teal.

"Jimmie Ray, that be my husband Nellie's kin. You find him?"

"No, ma'am. I'm sorry." As I listened, the missing piece in Jimmie Ray's biological profile clicked into place. The cadence of Mona's speech told me the Teals were of African-American descent.

"Well, you ain't calling to say he's passed, so praise the Lord for that."

"Does Jimmie Ray live with you?"

"Lordy, no. Jimmie Ray jus' kinda floats around down by the docks. He's not real good in the head."

I was confused. "If Jimmie Ray lives on the streets, how do you know he's missing?"

"I make that poor lamb fried chicken every Monday, see it as the Lord's work. Monday back one, Jimmie Ray come early, said he wanted to shower 'cause he's goin' to the doctor. He does that now and again, uses our place to clean his self up.

"Jimmie Ray starts telling me about a rash he's sufferin'. Lord, I didn't want to hear about that. He's barely here, then off he goes. Never come back. That ain't like Jimmie Ray. Boy's set in his ways, don't cotton to nothing altering his routine. When he misses two Mondays runnin', I know something's amiss. Jimmie Ray sure do like my chicken."

"Do you know where Jimmie Ray was going for his appointment?"

"Weren't no appointment. Jimmie Ray couldn't afford no private doctor."

"Oh?" Calm.

"Uses the free clinic over to Nassau, same as Nellie and me."

"The GMC clinic?" Calm.

"Tha's it. No appointments there. You sit your bottom down, wait your turn."

I gave Ryan a thumbs-up. Taking a hand from the wheel, he returned it, knowing I'd just tied Teal to the clinic.

"Thank you, Mrs. Teal."

"You find Jimmie Ray, you tell him his chicken's waiting."

I clicked off and raised a palm. Ryan high-fived it.

"And then there were three," I said, dialing Gullet.

My jubilation was cut short when Gullet's receptionist said her boss was absent until Tuesday. I stressed the importance of my contacting him. She said the sheriff had gone fishing and could not be reached.

Call Emma? I decided to wait until I'd researched the meaning of the neck fractures.

Pete was out when Ryan and I got back to "Sea for Miles." A blessing. Their alpha male routine was getting real old.

I went straight to my laptop and got online. Suspecting I'd be occupied for some time, Ryan set off in search of climate-appropriate clothing.

I started with the Journal of Forensic Science, bombed, moved on through a dozen more forensic publications. Two hours later I was out of ideas. Though I'd learned a lot about injuries due to traffic accidents, hockey, diving, and "spear-tackling" in football, nothing fit the pattern I was seeing. Try as I might, I couldn't remember where I'd encountered the report I was remembering.

I stared at my computer screen, frustrated, wondering for the billionth time if anything really connected these cases. Cruikshank, Helms, and Montague all exhibited unilateral neck fractures on the sixth cervical vertebrae. Helms and Montague had nicks in their lower back area. Montague was a patient at the GMC clinic. Jimmie Ray Teal was a patient at the GMC clinic. Helene Flynn had worked there.

Montague, Helms, and Cruikshank were dead. Teal and Flynn were missing.

Lonnie Aikman was missing. Susie Ruth Aikman was dead. Had mother or son been a patient at the GMC clinic? Were the Aikmans tied in at all? Were Cruikshank's other MPs?

It had to be the clinic.

Helene Flynn had complained about the clinic to her father before terminating contact with him. And to Herron. Cruikshank had been observing the place.

Or had Cruikshank been observing the people?

On impulse, I Googled the name Lester Marshall. I learned about an Arabian horse breeder and a guy who teaches qigong energy therapy, whatever that is.

When I added "Dr." to the name I was piped into a physician research service. For $7.95 the site promised to cough up everything but a doctor's grandmother's favorite recipe.

Why not?

My eight bucks got me the following.

Lester Marshall's address and phone number at the Nassau Street clinic. Now there was a buy.

Marshall's MD was earned at St. George's Medical School in Grenada.

Marshall's area of practice was family medicine, though he held no board certification in any medical specialty.

Marshall had done no residencies or fellowships.

Marshall had been on staff at a hospital in Tulsa, Oklahoma, from 1982 until 1989. He'd hired on with GMC in 1995.

Marshall had been the subject of no state or federal disciplinary actions.

I was printing my results when I heard the front door. From the swishing and crinkling I assumed shopping had been a success.

"Any luck finding your article?" Ryan asked, kissing the top of my head.

"No. But I did a little research on Lester Marshall." I handed Ryan my report.

"Grenada? That a real med school?"

"I think so. Though it's not exactly Johns Hopkins."

"Patchy employment history," Ryan said.

"Exactly. Where was Marshall from eighty-nine to ninety-five?"

"Wonder why he left Oklahoma."

"If Marshall got into trouble in eighty-nine the site wouldn't provide that information. They don't collect data on malpractice or lawsuits, and they don't report disciplinary actions older than five years."

"Did you try the pit bull and Daniels?"

I shook my head.

While Ryan took his purchases to the bedroom, I Googled Corey Daniels and Adele Berry. Nothing relevant came up. When I tried the Charleston white pages, I found a Corey R. Daniels on Seabrook Island.

A nurse living on Seabrook? That was odd. Seabrook and Kiawah islands were some of the priciest real estate in the Charleston area. Nothing low end.

I was thinking about that when Ryan reappeared. He was wearing a black cap with the brim turned backward, black Teva sandals, black shorts, and a black T depicting a devil clobbering an angel with a flashlight. The message read: Electricity comes from electrons, morality comes from morons.

"Nice," I said. Black, I thought.

"I found the message inspirational."

I found it unintelligible, but didn't say so.

"Didn't want to go too preppy," Ryan said.

"Black works with the pink skin," I said. "Hope the babes can resist."

"That can be a problem."

"Want to take a shot at hacking into Cruikshank's computer?"

"Not my strength. But I'll lend moral support."

"Morality's for morons." Pointing at Ryan's shirt, I heard a "psst" in my mind.

What? Electricity? Flashlight? Angel?

Wham-o. It was the Pete's-Hornets-cap-Teal synapse all over again. My mind catapulted the name from somewhere deep in storage.

"Larry Angel!"

"How I love him, how I tingle when he passes by." Ryan mimicked the Carpenters into an imaginary hand mike.

"Not Johnny Angel, Larry Angel. He was a physical anthropologist at the Smithsonian for years. It wasn't a journal article, it was a book chapter."

Ryan followed me to the den and watched as I dug a volume from the stack I'd used as a mini-lending library for my field school students.

And there it was. A black-and-white photo of a sixth cervical vertebra showing a hinge fracture through the anterior lamina and a hairline crack through the posterior lamina of the left transverse process.

"Whoa," Ryan said.

"Yowza," I said.

Together, Ryan and I skimmed the text.

I went cold all over.

I knew how Montague, Helms, and Cruikshank had died.