Patient (23 page)

“Highly doubtful,” Alex replied.

“Why?” Vicki asked.

“Well, for one thing, that security guard standing behind Marcus was one of Malloche’s men.”

Chapter 32

FROM THE WINDOWS OF SURGICAL SEVEN, JESSIE could see the phalanx of news vehicles and police cruisers lined up along the streets a block away from the hospital, like strobe-lit spokes on a wheel. It was after eleven. The surgery on Claude Malloche was less than seven hours away.

Scrub nurse ... circulating nurse ... console technician ... Hans Pfeffer and one of his computer people ... Skip Porter ... Jessie decided to involve only a skeleton crew in the operation. One by one, she had contacted the team to notify each that the case they would be working on first thing in the morning was a matter of great urgency, and could only be done with MRI assistance. She guaranteed them a sizable bonus and assured them that there was no danger from exposure to Eastman Tolliver, who was in the ICU, isolated from the rest of the patients on Surgical Seven. Of the group, only the scrub nurse balked at the idea of coming in. Jessie actually resorted to having Richard Marcus call to assure the man that he would be placing himself in no danger. Finally, the team was set. Only Emily was missing, but Arlette had promised that she would be brought to the floor sometime during the night.

Jessie didn’t even bother to point out the obvious—that the way they were doing things, both surgeon and assistant would be operating with major sleep deprivation. Except for delaying the case so they could rest, which was simply not going to happen, there was nothing anyone could do about it.

Determined to have as few people as possible involved with Malloche, Jessie elected to forgo the standard pre-op medical clearance and instead had Malloche’s man Derrick help her wheel him down for a chest X ray and EKG, which she then had the appropriate on-call residents review.

Next came choosing an anesthesiologist. Jessie was pleased that Michelle Booker was available and willing to do the case. Booker, a descendant of slaves and the daughter of an uneducated single mother in Alabama, had finished first in her class at Tuskegee Institute, then first again at Harvard Med. She was already a full professor in her department, though she was only Jessie’s age. She was also intuitive enough, Jessie believed, to pick up on some of what was going on without asking too many questions. Jessie felt bad at having to involve anyone in such a potentially perilous situation, let alone someone as essential to the medical community as Michelle. But a great many lives hinged on Malloche’s surviving his surgery. The pre-op anesthesia evaluation was conducted in the recovery room on Surgical Eight.

“So, Mr. Tolliver,” Michelle said after she had completed her history and physical, “our plan is to put you to sleep initially so that the tiny robot can be worked into place. Then we will wake you for most of the remainder of the procedure so that Dr. Copeland can monitor your neurologic function while she resects your tumor. Do you have any questions regarding that or any other aspect of tomorrow’s procedure?”

“No,” Malloche said. “You’ve explained things well. Several days ago I was in the operating room, observing the robot at work on a case. I know what to expect.”

“That’s excellent. Still, I’m told that the sensation of being awake during one’s own brain surgery almost defies description. I plan to keep you sedated as much as possible, even though you won’t actually be asleep.”

“You’re the doctor,” Malloche said.

“Correction,” Michelle said. “I’m the anesthesiologist. That woman over there by the window is The Doctor, capital T, capital D. And you couldn’t do any better. Jess, do you have anything to add to what I’ve said? ... Jessie? ...”

Jessie was gazing out the window at nothing in particular. Booker’s description of the procedure had sent an idea flashing through her mind—something important, she was almost certain. But the notion had vanished before she could get a fix on it.

Now, an hour later, back on Surgical Seven, Jessie was still struggling to reconnect with the thought. Something Michelle Booker had said to Malloche had triggered an idea ... something ...

With Grace dogging her step for step, Jessie wandered around the Track, carefully pausing at each patient’s doorway. Although she tried to show interest in all of them, only two of the patients really concerned her at this moment: Sara Devereau, who continued to seem just a bit more sluggish than she had been, and Tamika Bing.

Tamika had made contact with Alex, and in fact was on-line continuously now with someone named Vicki. Jessie had risked going into her room twice during the evening and managed to come out each time with a message from Alex. The first, which she had read right off the screen, said simply:

I am with you. Please be careful. When is Malloche’s operation? A.

The second was more detailed.

We are working on penetrating the hospital. Understand that Orlis Hermann is Arlette Malloche and that there are three plus her and Malloche on Surgical Seven. Any more? Probable contact point will be the HRI-OR. Any idea where the soman might be hidden? Tamika, good job. Jessie, hang in. Be careful. We’re going to win. A.

With her captor standing so close, Jessie felt reluctant to speak to Tamika of anything but how she was doing. She did risk another pass with her stethoscope and some whispered words of encouragement. Then she remembered that all Malloche’s people she knew of were accounted for when she spoke by phone to Emily.

“Tamika, you’re doing great,” she whispered. “Tell Vicki there is at least one more of Malloche’s men outside the hospital.”

While Jessie continued listening to her chest, Tamika silently typed out the message. Moments later, Jessie was walking the halls again, frantically trying to reconnect with the thought that had eluded her on Surgical Eight. As she passed Claude Malloche’s room, she paused. Through the semidarkness, she could see the monster, asleep on his back, the sheet over his chest rising and falling with each easy breath. Jessie had never encountered anyone so depraved.

Aside from his wife and perhaps his cadre of trusted followers, there was no one in the hospital—hell, probably in the world—whose life meant anything to Malloche except as it served him. To assure a successful operation and subsequent escape, he would think nothing of killing every person on Surgical Seven, or possibly even hundreds more on the streets of the city. It was easy now for her to understand Alex’s hatred of the man and the obsession with bringing him down. If only there were some way she could enter Malloche’s room, crouch down by his bed, and make some sort of subliminal suggestion that he—

The thought was never completed. It yielded instead to the evanescent idea that had been tormenting her so. This time, though, the notion stuck in her mind like a well-thrown dart, and quickly grew in clarity. Afraid that something in her expression might betray her to the young terrorist Grace, Jessie turned from Malloche’s room and headed, as nonchalantly as she could manage, down the hallway. Her heart was racing. The logistics of her plan would be tricky, but there was a possibility, however remote, that it might work. And with so many lives at stake, she had to try. The first step might actually be the most dangerous. She had to chance going back into Tamika Bing’s room with one more message for Alex.

With Grace several paces behind, Jessie followed the Track back to the nurses’ station and slid Sara’s record from its holder. As before, she block-printed the message for Alex on a progress note sheet and waited until Grace’s attention was momentarily diverted before tearing the paper free from the binder rings and folding it in her pocket. Now, all she needed was some excuse to reenter Tamika’s room. Absently, she put her hand in her lab coat pocket. Her Game Boy was there. Sharing it with the girl wasn’t the strongest motivation for a return visit, but it was at least something. She pulled it out and approached Grace, yawning.

“Well, I think I’m going to turn in down the hall there,” she said.

“Good idea,” the woman replied coolly. “You need to be at your best tomorrow.”

“Before I do, though, I want to stop in seven-ten again just for a minute.”

“What for? You were just there.”

“The kid in there had a brain tumor taken out by me. The cancer had eaten away her speech center, and now she can only communicate by her computer. She has no games on it and she’s getting very bored. I promised her a go at my Game Boy.”

“You stay here. I’ll bring it into her.”

“I ... I need to show her how to work it. It won’t take but a couple of minutes.”

For an interminable few seconds, Grace mulled over the request. Then she shrugged.

“Okay. But make it quick. You need to get some rest.

Jessie reentered Tamika’s room. The girl, still propped in bed, was dozing.

“See her in the morning,” Grace whispered.

The sound was enough. Tamika awoke and instantly tapped on her tray table to get Jessie’s attention.

No new messages
, she typed.

Jessie shielded her from Grace and passed the progress sheet over.

FIND DR. MARK NAEHRING. URGENT HE MEET ME IN MRI-OR AT 6 A.M. BRING MAGICAL MEDS HE DEMONSTRATED AT RECENT GRAND ROUNDS. MATTER OF LIFE OR DEATH. JESSIE

“So, Tamika,” she said in a strong voice, “here’s that Game Boy I promised you. Let me show you how to run it. This switch right here ...”

While Jessie droned on, Tamika glanced down at the note and quickly typed it. Then, as Jessie handed over the electronic toy, she retrieved the paper and stuffed it deep into her lab coat pocket.

“Just what in the hell is going on here?” Arlette Malloche stormed into the room.

As Jessie leaped back from the bed, she noted that Tamika had instantly broken off contact with Vicki.

Good baby!
she cheered.
Send the message later
.

“Everything’s fine,” Grace said.

“Is it? It seems like the doctor’s been in here all night.”

“Just twice before this. She’s been in several rooms that much. This time, she was just dropping off a toy.”

“Well, she’s finished going into any patient’s room until Claude’s surgery is done. Dr. Copeland, a room has been prepared for you. Get to bed at once.”

“I want to see Sara Devereau,” Jessie said. “She may be in some trouble.”

“I said you’re going to bed, and that’s it.”

Suddenly, Arlette’s eyes widened. Jessie followed her line of sight to the telephone cord snaking from the wall outlet up under the bedsheet. Muttering a curse, Arlette pushed the tray table back from the bed. The cord straightened, then pulled the computer off the tray table and onto Tamika’s lap. Furious, Arlette slapped Tamika across the face, then, in almost the same motion, slapped Jessie as well.

“What is going on here?” she demanded. “Who connected this?”

Tamika, who never even flinched at being hit, tapped on the computer to bring Arlette around to see the screen. She typed

I DID IT. I WANTED TO E-MAIL MY BOYFRIEND.

“She’s mute from her tumor surgery,” Jessie tried to explain. “The computer is the only way she can communicate with—”

“Shut up!” Arlette snarled. “Grace, did she send any e-mails while Dr. Copeland was here?”

“None,” Grace said, clearly frightened. “You checked?”

“Yes ... yes, I checked everything she did.”

“For your sake, I hope that’s true.”

She snatched up the laptop, tore it away from the phone line, and lifted it above her head.

“Please don’t,” Jessie said. “It’s her only—”

Arlette slammed the computer on the floor. The cover flew off, the casing split, and the screen shattered.

“Get to bed,” she said. “Now!”

Chapter 33

THE VENTILATION SYSTEM TO THE SURGICAL tower was a series of aluminum tubes about the size of the opening in an MRI machine. Arms extended, Alex inched his way through the maze, using raised toeholds to move up from the entry port on Surgical Five. He wore a miner’s helmet with a spotlight above the brim and carried a blueprint of the system in one hand. In the other he clutched a tape measure with which he was keeping track of his progress and location. Strapped to his back was a small knapsack containing a slender video camera and a transmitter, as well as metal shears, drills, bits, and other tools for boring. His pistol was jammed into a shoulder holster tucked beneath one arm.

The circular shape of the Surgical Seven hallway made positioning the camera and microphone a problem. The ceiling over the nurses’ station was the ideal location, but it was unlikely he could get the setup in place there without one of Malloche’s people hearing him or noticing the tip of the fiber-optic camera. He had instead chosen a location just around the bend from the nurses’ station as the spot least likely to be detected and most likely to help monitor the situation on the floor. Now, to the best of his calculations, he was there.

He had always had difficulty being in tight quarters. Now, he had been negotiating the two-foot tube for over an hour. Each heartbeat seemed to echo through the cramped space. He was drenched in sweat and finding it hard to breathe. For increasing stretches of time, all he could think about was standing up. But there was no room to stand, and no place to go but forward.

He extended the tape measure and once again checked his position on the blueprint. As best as he could figure, he was twenty feet from the center of the nurses’ station. Off to both sides of him, narrow ducts snaked away to the patients’ rooms and core service area. The ducts helped to relieve some of the dreadful feeling of being unable to straighten up or even turn over, but the anxiety was still there every second. He worked the backpack off his shoulders and removed the metal shears and powerful drill. Two drill holes in the aluminum and he would be able to cut an opening large enough for him to work on a panel of the drop ceiling.

Easy does it
, he urged. He could do it and get out. He just had to stay calm.

It took a while, but finally the eight-inch-square opening in the ventilation pipe was complete. Alex shut off his headlamp for a time and lay in the darkness, regaining his breath and his composure. Silence was crucial now—absolute quiet and skill in handling the drill. Slowly, carefully, he set the bit in place and squeezed the trigger on the housing. The pressboard of the ceiling panel gradually gave way as flakes of the material spun off.

Slowly ... slowly.

Almost directly below where he was working, Jessie walked along the corridor toward the room that had been designated by Arlette as her sleeping quarters. Behind her followed the ever-present Grace, accompanied by Arlette herself. Suddenly, just as Jessie was precisely beneath the place where Alex was working, no more than a few feet from him, his drill bit caught on something in the ceiling panel. Before Alex could adjust and react, the drill housing spun out of his hand and dropped onto the panel with a thud that might as well have been the impact of a wrecking ball. The panel gave way at one end. Instantly, weapon ready, Grace leaped up and pulled the entire piece down. Alex, exposed above the opening in the aluminum, was fumbling for his weapon. But Arlette and Grace were way ahead of him.

“No!” Jessie screamed as they opened fire. “Noooo!”

Several shots caught Alex flush in the face, while a dozen or more slammed through the aluminum and into his body. A thick, heavy rain of blood fell from the ceiling, splattering on the floor and pocking Jessie’s white lab coat with crimson. Alex’s face, a red mask of death, pressed grotesquely through the opening in the aluminum.

“Oh God,” Jessie moaned. “Oh God ... Oh God ... Oh—”

“Jessie?”

Gentle hands pressed down on her shoulders.

“Jess, wake up.”

Soft, reassuring whisper ... warm breath on her ear.

The horror of the nightmare began to fade, and with it the almost painful rigidity in Jessie’s body. She was facedown, clutching her pillow in a near death grip, jaws clenched. Her scrubs were damp with perspiration. Slowly, she turned and blinked herself awake. Emily looked down at her, her face shadowed with concern.

“You must have been having a real bad one,” she said.

Jessie sat up, still trying to shake off the startlingly vivid dream. Then she threw her arms around her friend.

“Oh, Em. I’m so glad you’re here. I was worried to death about you. Are you okay?”

“Nothing that a week in the Caribbean won’t take care of.”

Jessie managed to stand. Leaning in the doorway, dressed in scrubs, his gun over his shoulder, was Derrick.

“What time is it?” Jessie asked, still less than fully awake.

“Five-thirty.”

“The OR. We’re due in the OR at six.”

“I know. There’s still time for you to shower and change. I brought a clean set of scrubs for you.”

“Have you had any sleep?”

“I’m okay. I understand from Mrs. Hermann that I’ll be assisting you and ARTIE in the OR.”

“She’s not Mrs. Hermann. Her name’s Arlette Malloche. Eastman Tolliver is actually her husband, Claude. They kill people for money.”

“The guy who had me tied up never said anything about who he worked for,” Emily replied, “but I’m not surprised. My, my. I guess this means Carl won’t be getting that big grant.”

Jessie grinned momentarily.

“Guess not,” she said. Her expression darkened. “Lisa Brandon, the candy striper who was so kind to Sara, was actually an FBI undercover agent. Carl got her killed by losing his temper and forcing her to disclose who she was. Since then he’s come damn close to getting himself killed as well.”

“He’s bunked in the room next to yours and—”

“Sara!” Jessie exclaimed.

“What?”

“Sara—I’ve got to get in to see her. Arlette wouldn’t let me last night. She was starting to seem, I don’t know, sort of sluggish.”

“Jess, she’s been sluggish since she woke up.”

“I know, but she seemed more so to me.”

“Okay, I’ll go check on her. You shower. Here are the scrubs.”

Jessie took the clothes and turned to Derrick.

“Can my nurse, here, go to check the woman in seven thirty-seven?”

“If Arlette says it’s okay.”

Derrick radioed down the hall, and in a minute, Grace appeared at the door.

“Tell her I’ll be down as soon as I’ve changed,” Jessie said.

As Derrick followed Emily down the hall, Jessie checked the ceiling, half expecting to see it stained with Alex’s blood. How much prophecy was there in her dream? She also wondered if Tamika had managed to send the message about Mark Naehring before her laptop was destroyed. If so, they had a chance. If not, there was really nothing else she could think of to do. She would just have to perform the best surgery she could and pray that ARTIE functioned to its potential, and that Malloche recovered and made it out of the country without any more killing. Deep inside, though, she knew that praying for no more killing was wishful thinking. Claude and Arlette Malloche were animals—animals with their teeth on the throat of the hospital and, indeed, of the city.

Grace closed the door to the hallway and stood by the open bathroom doorway while Jessie undressed and stepped into the shower. Hot water, soap, and shampoo did good things for her flagging morale. Alex and Emily were still alive, and even Carl had survived. Tamika Bing had broken through her horrible depression, and had helped put a long-shot plan in motion. Jessie closed her eyes for a time and let the hot water beat against her face. She was toweling off when Emily came bursting into the room.

“Jess, come quick,” she said, breathlessly. “It’s Sara. She’s in big trouble. I think she may be going out.” Jessie grabbed her glasses, pulled on the fresh scrubs, and bolted past Grace and down the hall. Sara indeed was
in extremis
. She lay motionless in bed, unconscious and unresponsive to voice or touch. Her respirations were labored. Her pupils were dilated and barely reactive to light—a sign that there was massive brain swelling, which was pressing a portion of her brain stem up against a bony ridge on the floor of her skull.

“Acute hydrocephalus,” Jessie said. “I’d bet the ranch on it.

Something—possibly a small clot or piece of scar tissue—was obstructing the flow and drainage of Sara’s spinal fluid. The fluid, which was formed in the choroid plexus organ in the brain, was now blocked from flowing throughout the central nervous system and down around the spinal cord. But production of fluid by the plexus was continuing, and the resulting buildup of pressure within the rigid containment of her skull was about to become lethal. Jessie cursed herself for not being more aggressive last night when she had sensed that something in her friend’s condition might be changing.

“I’ll call the OR,” Emily said. “The team should all be in by now.”

“You’ll do no such thing!”

Arlette Malloche barged into the room and confronted Jessie.

“This woman must have an immediate drainage procedure to relieve the pressure that’s building up in her brain,” Jessie said. “She needs to be brought to the OR right now.”

“The only person who will be brought to any OR right now is my husband,” Arlette said.

Jessie was about to beg for her friend’s life, but she stopped abruptly. To people like Arlette Malloche and her husband, begging was nothing but a sign of weakness—certainly nothing to be respected. Instead, Jessie confronted the woman with all the hatred, all the fire, that had been building inside her.

“Arlette,” she said, “I’m drawing the line here. Claude’s operation can wait until I perform the drainage procedure on this woman. I swear that if you allow her to die, there is no way I will operate on your husband, no matter what you do to me.”

Arlette gave her the haughty look of an Olympian goddess confronted by the demands of a mere mortal. Then she calmly took her weapon from her shoulder and forced the barrel of it between Sara’s teeth and deep into her throat. Sara’s reaction to the violent insult was a faint, impotent gag and some involuntary movement of her arms.

“My husband is due to head down to the operating room in fifteen minutes,” Arlette said. “If you are not there with him, I will begin killing one person on this floor every minute until you are, beginning with this woman right here. Do you understand?”

Jessie and Emily exchanged looks.

Is it worth calling her bluff?
they asked one another.
Right here—right now, simply refuse to operate on the man
.

Jessie was well aware of the answer. The price of that hollow victory was hardly one she was willing to pay. She cared about the lives of others, and Arlette knew that as well as she did, just as she knew that Arlette cared not at all. The clash of wills, at this moment at least, on this battleground, was no contest.

“I understand,” Jessie said quickly. “Now please, take that out of Sara’s mouth.”

“Fifteen minutes,” Arlette said, withdrawing the muzzle. “Don’t test me on this.”

She turned toward the door.

“Wait!” Jessie cried. “There is something I can try right here.”

Arlette made a regal turn and assessed the faces around her. It was as if she saw the chance to become something of a benevolent despot in the eyes of the staff and her people. There was everything for her to gain by relenting here and nothing to lose.

“You have ten minutes,” she said. “At five of six, I want you out of here, accompanying my husband to the operating room.”

“One thing.”

“Yes?”

“Your people took a piece of equipment from me that I need right now—a twist drill. It looks like a big screwdriver with a black handle and a drill bit at the other end.”

“It looked like a dagger to us.”

“I’ll need some other equipment, too.”

Arlette nodded to Grace, who motioned Jessie out of the room and followed her off down the hall.

“Don’t do anything stupid,” Arlette called after them.

By the time Jessie returned with her twist drill, a scissors, a prep razor, a hemostat, and a Silastic catheter, three minutes of her ten had elapsed. Even worse, one of Sara’s pupils had become larger than the other and no longer constricted in response to the beam from Jessie’s penlight. The lethal brain-stem herniation and compression was happening. Perhaps sensing that death was in the offing, Arlette had chosen to remain in the room to monitor the procedure.

“I should have made this diagnosis last night,” Jessie muttered as she and Emily shaved away some fine new hair from the top of Sara’s scalp, an inch back from her front hairline, and just to the right side of the midline. “I could have taken her to the OR and done this right. Now it’s too late. It ... it was just crazy here last night. I should have taken a stand then.”

“Just do what you can do, Jess,” Emily said. “We both know she still has a chance.”

They pulled Sara down in the bed. Jessie gloved, then climbed up on the mattress, beside Sara’s head. Next she squirted some russet-colored Betadine antiseptic on the spot and on her drill, and began manually twisting a hole into Sara’s skull. There were less than five minutes left. The procedure did not go quickly. The twist drill was as much standard equipment to a neurosurgeon as a stethoscope was to an internist. But it was used infrequently and only in the most dire emergencies. Jessie began to wonder if she had the arm strength to complete the procedure.

Across the room, Arlette, positioning herself so that Jessie could hardly miss the movement, brought her weapon off her shoulder, and cradled it in front of her.

“Two minutes,” she said.

“Hand me that catheter and a hemostat, Em, please. I’m through the dural membrane.”

Jessie snapped one end of the catheter into the hemostat, tunneled for an inch beneath Sara’s scalp, and pushed it through the skin to the outside. Then she grasped the other end and worked it through the hole she had just made in the skull and dura, and down toward the ventricle chamber, where the mounting pressure was greatest.