Patient (16 page)

Hans Pfeffer made his way over to her and pulled her aside.

“Do something!” he whispered.

It was the most animated she had ever seen the laconic Dutchman.

“You have a suggestion?”

“There’s the microphone. Tell him to stop. The robot’s just not ready for this.”

Oh, ARTIE’s ready, all right
, she wanted to reply.
Ready and able.

“Hans,” she whispered back, “Carl is chief of this department, and one of the most powerful men in this hospital. He controls my job, and I would bet a good portion of your research funds as well. Nobody would survive busting in on him in the middle of a case with an audience like this. Nobody.”

There were concerned murmurs in the crowd now as first the other radiologist then the two neurosurgeons observing the case picked up on what was happening.

“Get in there!” Hans whispered. “Jessie, get in there before—”

Pfeffer stopped in midsentence. He and Jessie stared at the screen where a faint gray puff had just appeared, right at the snout and just to the left of ARTIE, clearly outside the boundary of the tumor. The smudge was tiny but unmistakable, and it was definitely expanding. A deep arterial hemorrhage—the neurosurgical equivalent of a nuclear explosion. Guided off course by Carl, one of ARTIE’s pincers had torn an artery. Seconds later, Gilbride’s strained voice came over the intercom.

“Dr. Copeland, are you still out there?”

Jessie ran to the microphone over the console.

“I’m here.”

“You see what’s going on. ARTIE’s malfunctioning. Could you come in here, please?”

On the screen, the hemorrhage was continuing to grow. Count Rolf Hermann had begun writhing as the pain caused by rapidly building pressure deep within his brain overcame the twilight anesthesia that had been used for his functional MRI.

“Pramod,” Jessie ordered to the anesthesiologist, “put him to sleep and drop his pressure. Give him forty of Lasix and a hundred of mannitol
stat
. Carl, I’ll be right in.”

The crowd parted as Jessie made a quick check to be certain she was wearing no metal, pulled on a hair covering and mask, and hurried into the OR. The scrub nurse was waiting with gloves and a gown. Danl Toomei stepped back from his spot between the tori across from Gilbride to allow her in. As she moved into his place, she looked over at Gilbride. What she could see of his face was blanched, but there was no way to read his eyes. Above and behind Gilbride’s right shoulder, looming like a surgical specter, seemingly transfixed by the scene, was Eastman Tolliver.

“Enhance the hemorrhage, please,” Jessie said.

“Roger that,” one of Pfeffer’s people in the lab upstairs replied.

In seconds, on her screen and Gilbride’s, the blood leaking into Hermann’s brain was transformed into a crimson grid. Almost certainly, the torn vessel was a branch of the left anterior cerebral artery.

Gilbride cut off the sound. He leaned forward so that no one but Jessie—not the scrub nurse, not even Tolliver—could hear what he was saying.

“It ... the robot just broke down,” he whispered. “I couldn’t control it.”

“I know,” Jessie responded.

“That hemorrhage is huge already. Pressure’s building. What should we do?”

“Fry it,” Jessie said simply. “Do you mind if we switch sides so I can get at ARTIE’s guidance console?” Gilbride hesitated. It required no telepathy to know why. His patient’s life versus the humiliation of giving up the principal surgeon’s spot in front of a large audience—for most not a difficult call, but for Carl, gut-wrenching. Jessie was about to remind him that he could always blame the disaster on a mechanical defect, when he apparently reminded himself.

“Come on over,” he said.

Jessie took her position at the control panel and switched on the microphone.

“Hey, guys,” she called to the crew upstairs, “see if you can get me some sort of enhancement of the left anterior circulation and a leaking artery just branching off it. I’m going to try and swing ARTIE around and cauterize the tear.”

“We copy,” came the heavily accented voice of Israeli programming wizard Manny Geller.

The neodymium-YAG laser—YAG for yttrium aluminum garnet—was a relatively recent addition to ARTIE, giving it the power to cauterize along with its existing abilities to melt tissue with ultrasound and to suction debris and fluid through a fairly large tube. This would be the first time Jessie had used the laser on human tissue. But there was no time to open up Rolf Hermann’s skull and go after the bleeder directly.

The image beamed down from the computer lab was exactly what Jessie wanted.

“There it is,” she said. “See?”

The leaking vessel was microns from ARTIE. The trick would be to back the robot up and turn it slightly. Slowly, but with unerring control, Jessie completed the maneuver.

“Okay, cross your fingers. Ready, aim ... fire.”

She depressed the button-controlling the laser beam. The blood surrounding the leak instantly boiled. Immediately, the expanding hemorrhage stopped. For one minute, two, they stood there in silence, watching the screens.

“Jessie,” Hans Pfeffer called in, “the bleeding’s stopped and the repair seems to be holding. Well done. Well done.”

Someone standing near Pfeffer began clapping, then several more joined in, the sound reverberating through the speakers in the OR. Moments later, the OR staff in the room was applauding as well—all except the man standing across from her.

“Nicely done, Doctor,” Gilbride said, loud enough for all to hear. “I’m afraid it’s back to the drawing board for our friend ARTIE.”

“Before we bring ARTIE out, I want to try and aspirate as much of the hemorrhage as we can.”

“Please do. After Count Hermann wakes up, we’ll have to discuss removing the rest of the meningioma sometime in the future.”

Jessie stared at her boss, but said nothing. She had seen enough miracles, including the one in NICU 6 right now, to know that anything was possible. But the truth was, Rolf Hermann, or Claude Malloche, or whoever the man lying there was, had about as much chance of waking up from this tragedy as she did of winning the lottery.

Chapter 21

KNOWING THE SPACE-AGE EFFICIENCY OF THE hospital grapevine, Jessie was certain that word of the fiasco in the MRI-OR had spread throughout the hospital by the time Rolf Hermann was transferred to the NICU on Surgical Seven. His condition was listed with the switchboard operator as critical, but that really did not tell the whole story. The Count’s pupils were dilated and unreactive to light or any other stimulus. The Babinski sign—an upward movement of the great toe when the sole of the foot is stimulated—was present bilaterally, signifying that there was essentially a functional disconnection of the brain from the rest of the body.

Carl Gilbride was distracted and irritable, and several times snapped at the nurses as his patient was being transferred to the unit bed. For brief moments, Jessie actually felt some sympathy for the man. But in the main, she was disgusted with him and not a little embarrassed for the department. The combination of his hubris, greed, and inflated opinion of his surgical skills had led him to a series of decisions that would ultimately cost a life and, in all likelihood, a four-million-dollar grant as well. Now he had insisted that Jessie accompany him into the family room to speak with Orlis Hermann and the Count’s sons and daughter. Orlis was waiting for them in the family room along with her stepdaughter and one of her stepsons. Jessie mused on where Hermann’s other son might be at so critical a time, then took a seat behind Gilbride. As she surveyed the family, she wondered if Rolf Hermann’s beautiful wife could really be, as Alex claimed, an assassin and hardened mercenary, and if the grown offspring, sitting there statue-like, could be nothing more than bodyguards, chosen from Claude Malloche’s elite inner circle. If these people were capable of murdering Sylvan Mays, who hadn’t even performed an operation on Malloche, how would they treat the ones who had botched it?

Tone it down, Carl, she was thinking. Tell them it’s bad, but for God’s sake, don’t tell them it’s hopeless.

“Well,” Gilbride said, tenting his fingers in a blatantly pensive pose. “I’m afraid the news isn’t good. Things started off well enough, and we had a good deal of the tumor removed, but then we ran into some ... problems.”

“Problems?” Orlis said stonily.

“Mrs. Hermann”—Gilbride paused as if searching for words—“during the operation, your husband had a fairly large hemorrhage into his brain.”

“A hemorrhage? From what?”

“I can’t say for certain. Sometimes, during major surgery, arteries just ... rupture. In this case, with the Count’s tumor situated so deep in his brain, it’s possible that an artery might have been nicked and bled.”

Orlis quickly translated in German for the Count’s offspring. The son asked a question, which she answered. Jessie tried to get a read on the group, but failed completely. If they were all killers, then they were damn fine actors as well. If they weren’t killers, then Alex was either dead wrong, or a deadly sham himself.

“What can we expect now?” Orlis asked.

Please
, Jessie pleaded silently.
Please tell them there’s hope
.

If Gilbride handled things right, at least there might be time for Alex to make a move before anyone got hurt.

The neurosurgical chief shook his head grimly. His expression was tight and severe. Jessie had seen the look before. The man was preparing to paint the bleakest picture possible in hopes that any improvement would make him look good. It was exactly what she had been praying he would not do.

“Well,” he said, tenting his fingers again and looking down at them, “the hemorrhage was quite extensive. Dr. Copeland and I were able to use our intraoperative robot to cauterize the vessel and stop the bleeding, but I’m afraid by that time a good deal of damage had been done. I—”

“Dr. Gilbride,” Orlis said, her blue-white eyes impaling him, “would you please stop mumbling and stalling and tell us if my husband is going to survive this.”

No!
Jessie’s thoughts screamed.
Don’t react!

“Mrs. Hermann,” Gilbride replied, clearly frayed, “I know you’re upset, but I do not appreciate being spoken to like that.”

“I brought you a man who was completely intact, and you hand me back a ... a vegetable. What do you expect, praise?”

Jessie couldn’t remember the last time she had seen Gilbride so uncomfortable. He stood and faced Orlis, his arms folded across his chest, his cheeks flushed.

“Mrs. Hermann, you and Count Hermann read all the possible outcomes of his operation and attested in writing to your acceptance of them. Now, we’ll continue doing everything we can for him. When there is any news to report, we’ll find you. In the meantime, beginning tomorrow afternoon, for the forty-eight hours I’m in New York, Dr. Copeland will be covering my service.

“New York!” Orlis exclaimed, almost in unison with Jessie.

“I’m due to sit on a panel at a very important conference tomorrow afternoon at NYU,” Gilbride said with far too much pride in his voice.

For God’s sake, Carl, can’t you hide that outrageous ego for once? Our lives could depend on it.

“Dr. Gilbride,” Orlis said with chilling calm, “I promise you that if you leave Boston with my husband in this condition, you will regret it.”

Jessie expected a combative response from her chief. Instead, Gilbride just stood there, transfixed by the woman.

“We’ll talk about it in the morning,” he said finally, in a strained, unnatural voice.

Without so much as a glance at Jessie, he turned and hurried from the room.

Jessie forced herself to remain still—not simply to leap up and follow him.

“He’s very upset,” she managed to say.

“You’d best speak with him, Doctor Copeland,” Orlis replied with her same frightening calm. “Tell him I meant what I said. I don’t want him leaving this hospital for any reason other than to go home and rest. If he deserts my husband, he will regret it.”

Regret as in Sylvan Mays?
Jessie wondered.

“I’ll tell him,” she said.

“RAISE YOUR RIGHT hand. No, Devereau, your
other
right hand. Are you ragging on me?”

“Just... want see ... if you were pay ... attention,” Sara said thickly.

With great effort, she raised her right arm off the bed and issued a clumsy but unmistakable thumbs up. Jessie answered her in kind.

Progress, progress, progress
, she chanted to herself. All that ever mattered in neurosurgical post-ops was progress. And progress Sara most certainly was making.

Shaken by the exchange with Orlis, Jessie forced herself to focus through the neuro check on her patient. Orlis ... Alex ... Gilbride ... Malloche. In the kind of acute-care medicine she practiced, distraction was often the touchstone to disaster. She was beginning to feel smothered. She badly needed to talk to
someone
about what was happening. Emily DelGreco was the only candidate.

Jessie wrote down the order to keep Sara in the NICU, although clinically she no longer needed it. The nurses on the floor were quite good, but the ones in the unit were special, with a bulldog determination to do whatever was necessary for their patients’ recovery. Until utilization review began making a fuss, or the bed became needed for someone else, or Sara jumped up and demanded a transfer herself, she would remain right where she was.

By the time Jessie had finished writing, Sara was asleep, exhausted. Jessie brushed her cheek gently, then headed to the phone at the nurses’ station.

Emily had begged off work for the day. There was a show at her younger son’s school. Jessie hoped she could reach her at home. It would be a huge relief to share the burden Alex had placed on her.

Emily’s oldest, Ted, answered.

“Mom’s not here, Jessie. She went out an hour or so ago. I thought she was with you.”

“Why would you think that?”

“She got a phone call, then she said she had to go to the hospital for a while.”

“Did she say who called her?”

“Nope. I just assumed it was you.”

Jessie shifted nervously. The DelGrecos lived in Brookline, just a short way from Eastern Mass Medical. If she had left an hour ago, she would be here by now.

“Your dad home?”

“Nope. He almost never gets home before seven.”

“When he does, would you ask him to page me at the hospital?”

“Sure.”

“And if you hear from Mom, tell her the same thing.”

“Okay. Is something the matter?”

“No, no. Just some stuff going on with one of the patients that I want to check with her about. This place is so huge that your mom’s probably in another part of the hospital right now. I’ll have her paged.”

“You still have that pinball machine in your apartment?”

“Of course. You’ll have to come over sometime soon and play. As I recall, you came close to my record last time.”

“Hardly close. But I’d like another try. That was fun.”

“Take care, Ted.”

Jessie set the receiver down and immediately paged Emily. Fifteen minutes went by without a return call. Jessie was hunched over Sara’s chart, writing a progress note, when Alex Bishop startled her from behind.

“Hey, Doc,” he said softly.

“Jesus, don’t sneak up on me like that! Clear your throat or something.”

“Sorry.” He looked about to ensure no one was listening. “Can I talk to you?”

“Alex, I still don’t know if I feel comfortable saying anything to you about our patients.”

“You don’t believe what I’ve told you?”

“I ... don’t know what to believe.”

He passed over a piece of paper.

“Here’s a phone number in Virginia. Ask for a man named Benson, Harold Benson. He’s head of internal affairs at the agency. They’re the ones who are after me. He knows me and what I’ve been doing these past five years. If you tell him the situation and ask him nicely, he might say who I am.”

“It won’t prove anything. These phone things can be set up.”

“Okay, then, Doctor,” he said, his eyes narrowed and hard, “play it any way you want. I said I was sorry for not starting with the truth. I can’t do any more than that. With or without your help, I’m going to bring Claude Malloche down. If people get hurt in the process, it’ll be on your head as much as mine.”

He turned and started down the hall.

“Wait,” Jessie called out, stopping him. “What do you want to know?”

Alex walked slowly back. The intensity in his eyes was still there, but not the unsettling hardness.

“Thank you,” he whispered. “What’s the situation?”

“Your friend Hermann, or Malloche, is in room two on a vent,” she said, feeling relief at having, made a decision.

“So I saw. Is he going to wake up?”

Jessie shook her head.

“Stranger things have happened,” she said. “But in my opinion, if he wakes up, look for a star in the east.”

“How long can he go on like this?”

“I couldn’t say. Hours? Weeks? I’ve been surprised both ways.”

“”But he’s not going to wake up.”

He had a hell of a hemorrhage. There’s been pretty massive brain damage. That’s all I can say.”

“Okay. As far as I know, Jorge Cardoza will be on his way here from Madrid tomorrow. If Hermann is still on the respirator, we’ll have to find a way to get Cardoza into the hospital without having him run into the wife.”

“If it comes to that, I’ll see what I can do to help. Right now, Orlis is in a pretty foul mood.”

“Her name’s Arlette, remember?”

“Orlis, Arlette—whoever she is, she just threatened Dr. Gilbride.”

“She did what?”

“He said he was flying to New York tomorrow to be on some sort of panel, and that I’d be in charge of the Count while he was gone. She told him he’d regret it if he did. Carl was pretty shaken up.”

“Good. That could save his life. Maybe it’s time to tell him what’s going on—who he’s dealing with.”

“And you’re certain who that is?”

“Virtually. Interpol hasn’t been able to come up with any match for the fingerprints I sent them. But that’s not surprising. They have a few dozen sets on file from assassinations that are believed to be Malloche’s work, including those murders at that MRI clinic in France. But it’s possible not a single one belongs to him.”

“Or they could all be Malloche if he’s more than one person.”

“Nice theory. But he’s only one person all right. That guy right in there. How did Gilbride screw up so badly in the operation?”

“He shouldn’t have read his press clippings after the Marci Sheprow surgery. That’s how.”

“If Malloche dies, I want his body.”

“If Malloche dies, I want protection for Carl and me.”

“I’ll find a way. Meanwhile, we’re going to stay on the job.”

“We?”

“I told you I had a little help.”

“But—”

“That’s all I can say.” He scribbled a phone number on a piece of progress note paper. “This is an answering service here in Boston. They have instructions on how to contact me if necessary. If anything happens to Hermann, just call and tell them. We’ll wait it out until Cardoza arrives. Meanwhile, if Malloche dies, I’ll be going after his body, his wife, and those three junior killers. Once we get a positive ID from Cardoza and then get Arlette Malloche and her so-called stepchildren into custody, we’ll learn what we need to know.”

“You scare me, Alex.”

“Sometimes, even after all these years, I scare myself. Jessie, I know how difficult it was to decide to help me. Thank you for trusting me.”

“I don’t,” she said.

JESSIE WATCHED AS he made his way down the corridor, pausing just long enough to glimpse into room 2 as he passed.
Five years
. Almost as long as it had taken her to complete her neurosurgical residency. It was a hell of a long time to chase an obsession—especially with so little success. Now, with no firm proof that the patient in 2 was Malloche, and with the man so near death, it was possible Alex’s quest would end not with a bang, but with the whimper of lingering uncertainty.

Jessie checked the time—nearly twenty minutes since her page to Emily had been sent. She wondered if Emily’s beeper could possibly be malfunctioning or might simply have been turned off. At that instant her own pager sounded. The display gave Alice Twitchell’s name and extension.