seeing the doctor for congestive heart failure or getting their toenails clipped. Nesbitt owed the state of Georgia $2,655. His commissary account and three-cents-an-hour janitorial wage were being garnished until the debt was resolved. If he ever got out of prison, that money would continue to be garnished from whatever paycheck he managed to earn. In the last eight years alone, Nesbitt had required 531 medical visits and 28 hospitalizations. That was more than one visit per week.
Sara told Amanda, “Nesbitt’s foot was amputated after a car accident. He’s lost four inches of leg since he became incarcerated. He was poorly fitted for a prosthetic. A bad prosthetic is like a shoe that doesn’t fit. The rubbing and friction occludes normal capillary pressure. The tissue becomes ischemic. If this goes on long enough, which it’s bound to in prison, the tissue becomes necrotic.”
“And then?”
“Then—” Sara paged through the chart, which was a case study in Third World medicine. “Diagnostically, you stage the damage based on what you can see. Stage I is superficial, just a red patch. Stage II involves the top two layers of skin. It looks like a blister, basically. Stage III is an ulcer with full thickness. That’s an open sore. You can see the fat, but the bone and muscle aren’t visible. There’s a white or yellow slough that has to be wiped away.”
“Pus?”
“More like a slimy film. It smells awful. You have to keep it clean or you’ll develop an anaerobic bacterial undergrowth.” Sara noted in the chart that bacteria had repeatedly set up in Nesbitt’s leg. Inmates were not allowed to keep medications inside their cells, and sterile cloths were hard to come by, especially at $5 each visit.
Sara continued, “Stage IV is a full-thickness ulcer. You can actually see inside the leg to bone, muscle and tendon. Past that, it’s technically unstageable because you can’t see anything. The skin develops a black, hard scar tissue that’s as thick as the sole of a shoe. You have to saw through it. The smell is putrid. Think of rotting meat, because that’s basically what’s happening. The muscle is destroyed. The bone becomes infected. Nesbitt has reached this point four times over the last eight years, and each time, they cut off a little bit more of his leg.”
“Is that the best way to treat it?”
Sara would’ve laughed if the situation wasn’t so appalling. “If you’re on a Civil War battlefield, absolutely. But this is the twenty-first century. The gold standard is to use a vacuum-assisted closure and ideally, hyperbolic oxygen treatments to bring blood flow back to the area. In the best of circumstances, it would take months of intensive wound care to heal.”
“The state would never pay for that.”
Sara allowed the laugh to come out. The state barely paid for clean sheets. “Nesbitt currently has a stage III, full-thickness ulcer. You’d be able to smell the rot if you stood close enough. He’s one, maybe two more infections away from losing his knee joint. That opens up a whole new set of problems. Even good candidates have trouble adapting to an AKA prosthesis.”
“He’ll keep losing sections of leg until there’s nothing left?”
“It won’t come to that. They’ll put him in a wheelchair. He won’t have access to physical therapy. His exercise will be limited. It’s almost impossible to stay well-hydrated drinking toilet water. He’s already carrying an extra twenty pounds. His blood pressure, cholesterol and A1c are elevated. Diabetes is right around the corner.”
“Another level of hell?”
“Rock bottom,” Sara said. “He can monitor his blood sugar in his cell, but he’ll have to go to the infirmary each time he needs an injection. You can imagine how well that system works. Hundreds of inmates die every year from diabetic ketoacidosis. Nesbitt is standing at the precipice of a cascade that is going to cut decades off of his life. Not to mention the trauma of what he’s already experienced.”
“You seem to have a lot of compassion for a pedophile who tried to sue your husband’s estate.”
Sara realized that Amanda had done some investigating on her own. The civil suit wasn’t mentioned in Nesbitt’s jacket. “I’m giving you a medical opinion, not a personal one.”
Still, Sara could hear her mother’s niggling voice: Whatsoever you do to the least of my brothers, you do unto me.
“It’s strange,” Amanda said. “Nesbitt never hinted at using his medical needs as a bargaining chip. We could transfer him to a hospital right now to treat his wound.”
“That’s a spit in the ocean. To really take care of him, you’re looking at north of a million dollars.” Sara laid it out for her. “A wound-care specialist. An orthopedist who specializes in limb salvage and amputation. A cardiologist. A vascular surgeon. A properly fitted prosthesis. Physical therapy. Quarterly adjustments. Complete replacement every three to four years. Nutritional support. Pain management.”
“I get it,” Amanda said. “Nesbitt must get it, too. That’s why he’s so focused on revenge. He’s determined to tarnish the Grant County force.”
“You mean Jeffrey.”
“I mean Lena Adams. He wants to see her behind bars.”
“Well what do you know. I’ve found common ground with a pedophile.” Sara paged back to Nesbitt’s most recent infirmary visit. “Absent a miracle, he’ll be in sepsis within the next two weeks. When the symptoms get bad enough, they’ll hospitalize him. Then he’ll be transferred back to prison. Then he’ll get sicker. Then they’ll hospitalize him. He’s been here four times. He knows what’s coming.”
“That explains his one-week deadline.” Amanda asked, “Can you recall anything about the Grant County investigation?”
“I can only give you a medical examiner’s perspective.” Sara tried to be diplomatic. During that time, most of her conversations with Jeffrey had quickly devolved into cheap shots and name-calling. “I was working as an advisor to the local coroner. Jeffrey and I weren’t on good terms.”
Amanda took a sharp turn onto a side street. Sara had lost track of time. They had already reached the Ingle Funeral Home of Sautee. Amanda looped around the building, then parked at the front entrance. She took out her phone to let their contact know that they’d arrived.
There was only one other car by the entrance, a red Chevy Tahoe. Sara looked up at the two-story brick building. Crisp white trim. Copper gutters. Alexandra McAllister was inside. She was twenty-nine years old. She had been missing for eight days. Her body had been found by two hikers who were out walking their dog.
Instead of silently wallowing in the past, Sara should’ve been drilling Amanda for details on the present.
“Two minutes.” Amanda was off the phone. “The family is about to leave.”
Sara asked the question she should’ve asked half an hour ago. “Do you think Nesbitt is right? Is there a serial killer?”
“Everyone wants to work a serial killer case,” Amanda said. “My job is to bring focus to the team so they stop swatting at flies and figure out where the rotting meat is.”
The front door opened. Silence descended inside the car as they watched a man and woman leave the building. They were both in their late fifties. Both bent over with grief. Alexandra McAllister’s parents, Sara assumed. They were dressed in black.
