Patient (3 page)

Jessie stepped back, clear of the tori, and looked over to Hans Pfeffer, shaking her head sadly. Then she moved back to her spot by the table. It would take an hour or more to back ARTIE out, if they could do it at all.

Across from her, the expression in Emily’s eyes, framed by her hair cover and mask, was grim.

“Thank you, everyone,” Jessie said suddenly. “You all did a great job. ARTIE’s close. Really close. But I guess he’s not quite there yet.”

She shut off the power to the robot, then took a scalpel and sliced through the control cord.

“Hans, thank you,” she said. “I’ll retrieve ARTIE at autopsy, and then we’ll give him an autopsy of his own.”

“Sorry, Jess,” Emily murmured.

Jessie pushed the monitor screen up toward the ceiling and pulled down her mask.

“Me, too,” she said.

She hated losing. God, how she hated losing. But at least this defeat hadn’t affected a living patient.

She pulled the drapes free and loosened the screws from the cadaver. Pete Roslanski had had a miserable six months before his glioblastoma took him. The tumor had already done irreversible damage when it was diagnosed. Surgery was out of the question. ARTIE, which even now had yet to be approved by the hospital’s human experimentation panel, could not have been used in any event. It had been a wonderful gesture on Pete’s and his family’s part to allow his body to be operated on this way.

“It’s a step at a time,” Emily said. “And today was a big one for ARTIE. He’s almost there, Jess. Just keep doing what you’ve been doing, and you’re both going to succeed. Just be grateful no one’s pushing you.”

“Yeah,” Jessie said flatly. “I am grateful for that.”

Chapter 2

ALEX BISHOP PICKED UP THE STACCATO TAPPING OF Craft’s cane half a minute before he actually spotted the man approaching from his left. Still, he remained motionless, as he had been for most of an hour, pressed against the base of a tree, with a clear view of all the accesses to the ED.R. Memorial. Mel Craft, now the deputy assistant head of the directorate of CIA operations, had promised he would come alone, and given their history, he had every reason to keep his word. But Craft was the ultimate Company man, and Bishop was nothing if not cautious. Surviving seventeen years as an operative in some of the diciest spots on earth was a testament to that.

It was six in the morning. Pale sunlight filtered through a broken sky and sparked off the wind-whipped chop on the Potomac. It had been nine months since Bishop had last been in D.C. By and large he couldn’t stand the place, but he considered the area around the river to be as beautiful as anything any other city had to offer. Two runners and a bicyclist passed the blind man, each unable to keep from glancing back curiously at him. No threat there. Bishop made a final visual sweep of the area and left his concealment, moving stealthily across the thick grass toward Craft. He was still five yards away when the deputy turned toward him.

“It’s okay, Alex,” he said in his heavy Mississippi drawl. “I’m alone.”

“There’s a bench twenty yards to your left. I’ll meet you there.”

“Jesus, Alex, if you can’t trust me, you are in a pretty damn sorry state.”

“You’re right about that,” Bishop murmured.

He watched until Craft was seated, then turned his back to the river and made a wide, wary arc before settling down at the far end of the bench, three feet away from his onetime partner. At forty-five, Craft was two years older than Bishop. But the torture that had ended his fieldwork, plus the twenty-five inactivity pounds he had put on since then, had added a decade to his looks.

“I can smell your gun,” Craft said. “What is it, under a newspaper?”

“The
Post
.”

“I’d like to tell you to put it away, that you don’t have anything to be so paranoid about.”

“But I do, right?”

“Alex, you were supposed to report in a month ago to begin your new assignment training the incoming class at the farm.”

“I can’t. Things are finally starting to break.”

“The powers that be already consider you a liability. And you know as well as I do that’s a very unhealthy thing to be considered, even if you’re not.”

“Mel, one of the powers that be is
you
. You’ve got to stall things for me.”

Craft removed his mirrored sunglasses and rubbed at the scarred craters where his eyes once had been.

“I can’t control some of the people you’ve upset by going AWOL,” he said.

“You’ve got to, Mel. Malloche is in trouble. He’s got a brain tumor of some sort.”

“How do you know?”

“I found out about the tumor from a source in France. The entire staff of an MRI lab in Strasbourg was wiped out, each with a single center shot to the forehead. That shot is the only thing Malloche has ever done with any consistency.”

“So?”

“So, a week ago the bastard surfaced here in the U.S.—in
Iowa
of all places.”

“How do you know? You’ve never even seen the guy. Almost five years chasing after him, and you’ve never even seen his goddamn face.”

Bishop ignored the jab.

“A neurosurgeon named Sylvan Mays and his secretary were killed in his office. Center forehead shot. One apiece.”

“I still don’t see—”

“Mays was one of the top neurosurgeons in the world. He’s developing a kind of robot that can reach tumors that were considered inoperable.”

“So why did Malloche kill him?”

“I figure Mays didn’t know who he was dealing with, and made some promises to Malloche that he couldn’t keep.”

Craft shook his head.

“Alex, there’s a pretty large contingent on Capitol Hill and even some people at Langley who don’t even believe Claude Malloche exists.”

“You know better.”

“What I know is that it’s over, my friend. The agency gave you three years, then four, then five. Now they want you home. I’m sorry you didn’t get him, Alex. But now you’ve got to accept that it’s over.”

Bishop slid a foot closer, tightly gripping the .45. Even blind and ten years out of the field, Mel Craft had more killing skills than most operatives.

“You thought it was over for you in El Salvador, too,” Bishop said.

Craft took a deep breath, then exhaled slowly. After fifteen hours of unspeakable torture at the hands of a right-wing death squad, he had been sightless, hopeless, and praying for death. Then the commotion had begun. A minute or so later, Alex Bishop was untying him, having killed all seven of Craft’s captors—three with his bare hands. El Salvador was Bishop’s trump card, and he had just played it.

“Okay,” Craft said finally. “What do you want?”

“Malloche is headed for a hospital in Boston.”

“How do you know?”

“There are only three other places in the country that are doing the same sort of research as Mays. This surgeon in Boston is the one people tell me is farthest along. If I can find that information out, Malloche knows it, too. I’m willing to bet he’s headed there right now.”

“I’ll do what I can, but I can’t promise anything. They want you real bad, Alex. In the fold or in a box.”

“I need some time, Mel. I need a cover to get me inside, and I need a contact at the local FBI. And all of it’s got to be done real quick and real quiet. Malloche always seems to know who to pay off.”

“And who to
knock
off. You really think this is it?”

“If it isn’t, I promise you, I’m done.”

“If I can’t convince Stebbins and his internal affairs thugs to back off, you may be done anyhow.”

“That’s my problem. Will you at least try?”

“If I do, I don’t want to hear any of that ‘remember El Salvador’ shit again. Agreed?”

“Agreed.”

“If it had been you tied to that chair, I would have tried the same harebrained one-man attack you did.”

“I believe you would have.”

“But this is no time to be harebrained, Alex. You’ve been part of this organization long enough to know how berserk internal affairs can get about someone they feel is a loose cannon. And operating inside this country definitely makes you one of those.”

“By the time they find me, it’ll be over.”

“Don’t underestimate them.”

“I won’t, Mel. I’ve stayed alive this long by not underestimating anyone. But if they come after me, they’d better send someone who wants to get me as much as I want Malloche. And I don’t think that person exists.”

“I’ll do what I can. Just watch your back.”

Chapter 3

“... ‘YOU MAY LOSE THE VISION IN ONE OR BOTH of your eyes.’ ”

“As long as it’s only one or both.”

“Okay, then. Initial here. ... ‘You may lose the use of one or both of your arms.’ ”

“Arms? I mean, really. What do I need arms for, anyhow? Show me
one
unhappy amoeba. I can scratch my back on a tree like the bears and eat pie like those guys in the county fair. Mmmmmm.”

“Initial. ... ‘You may lose the use of one or both of your legs.’ ”

“Jessie, please.”

“Sara, hospital policy says I have to read this neurosurgery op permit to you out loud, and you know what a policy nerd I am. So stop giving me a hard time and let me finish.”

 “Giving
you
a hard time? It’s
my
damn brain tumor.”

“Touché.”

Jessie set her clipboard aside and sat down on the edge of Sara Devereau’s bed. Sara, an elementary school teacher with three kids, was only thirty-nine. She was facing a third operation on an astrocytoma that had been maddeningly tenacious. Her first procedure, done five years ago by Carl Gilbride, might or might not have been adequate. Jessie had her opinion, but with only the op note and X rays to go by, she knew it wasn’t fair to judge ... even him.

She had assisted him on Sara’s second operation, nearly two years ago. When he announced he had finished the case, Jessie felt certain he had not been aggressive enough. But what could she do? At the time, she was chief resident. He was chief of the department.

Following the second procedure, she had gone out of her way to get to know Sara. Their contacts outside the hospital weren’t frequent, but they did manage a lunch or a late-afternoon drink from time to time, and twice Jessie had been invited to Sara’s home. The woman had taught her more about courage, more about taking life as it came, about adjusting to calamity, than any other patient she had ever had.

As she and Sara grew closer, Jessie had tried to understand—to place herself in Gilbride’s shoes that day; to forgive. But she could never free her memory of the overwhelming apprehension and helplessness she had felt the moment he suddenly stepped back from the table and announced that he had completed the reoperation on Sara, and had gotten as much tumor out of her brain as was necessary to effect a long-term favorable outcome. He had then stripped off his gloves and gown in the theatrical way that was his trademark and hurried from the OR to catch a plane to speak at an international conference, leaving Jessie to replace the skull flap and close the scalp incision over a cancer that she strongly feared had been inadequately excised.

Sara’s “long-term favorable outcome” had lasted just twenty-two months.

A few weeks before, with the sudden development of headaches and thickened speech, Damocles’ sword had finally fallen. The news from the MRI was grim. The surgery Sara was facing this time had a chance of being curative, but only a slim one. Her response to the devastating report was typical—whatever had to be done, should be done. She and her family would deal with it and make the best of it. If the cancer could possibly be overcome, she was determined to be the one to do it. As long as she was aware and moving about, she had precisely the same gift as did everyone else in the world—this day.

But she had insisted that this time Jessie perform the operation. And Gilbride, clumsily masking his relief, had turned over the reins.

Jessie and Sara were in room 748, one of ten private rooms on the neurosurgical floor, which occupied the seventh of eight stories of the Surgical Tower. Over the five years since its grand opening, the forty-five rooms and offices on Surgical Seven had been more of a home to Jessie than her Back Bay apartment.

It was nearing four in the afternoon. Jessie had just arrived on Surgical Seven for patient rounds, following an hour in pathology during which she had helped extract ARTIE from the late Pete Roslanski’s head. Tech Skip Porter, his jaw swollen like a plum from his dental encounter, had taken the tiny robot to their lab for a painstaking, under-microscope dissection. Jessie suspected that it wouldn’t be long before they had some answers. Upset though she was over ARTIE’s failure to complete the operation, she was pleased with the way it had performed in the early going, and totally relieved that she had gone with a trial run on a cadaver. From the early work guiding the robot through watermelons, to testing on pigs, then finally primates, she and Carl Gilbride had improved their technique just as she and Skip had improved ARTIE’s. Now, as soon as Skip had made a diagnosis, they would consider gearing up ARTIE-2 for another cadaver trial. Then, who knew? Maybe Gilbride would be ready to make a presentation to the human experimentation committee.

For the moment, though, ARTIE had to be Skip’s problem. Sara Devereau was just the first of twenty-two patients on the two file cards Emily had prepared for afternoon rounds. Jessie, locking in a commitment that would force her to leave the hospital before eleven for the first time this week, had agreed to meet her friend Eileen at a duplicate bridge game at seven forty-five. But Sara was also a friend, and the only one of the twenty-two who was pre-op for tomorrow. If there was any rushing to be done, it would not be in room 748. If Jessie couldn’t make it to the Cavendish Club, Eileen could always drag her husband, Kenny, away from his computer for the evening to play with her.

Emily’s extensive training, years of experience, and superb clinical judgment made it easy for Jessie to delegate responsibility to her. After sending her off to see the first few patients, she closed the door and returned to her spot on the edge of Sara’s bed. In a little more than twelve hours, their lives would be joined in a mortal struggle against a virulent, resilient cancer, that was eating away at Sara’s ability to move and think. There were things that needed to be said between them.

“Tomorrow’s going to be tough,” Jessie began.

Sara’s eyes held none of their usual playfulness.

“I’m running out of steam, Jess.”

“I know you are. I would have cracked long ago. You’ve been a titan. Everyone around here has gotten stronger from watching the way you’ve handled things—especially me. Sara, you and I both know I’m not God. But I promise you I’m going to do everything in my power to make this third one the charm.”

“I never questioned that, but it’s good to hear anyhow. You know, it’s funny. I’m ready—at least as ready as I’m ever going to be—for the surgery. But I keep having this weird, unanswerable question running through my head. How am I ever going to know that I didn’t wake up from the anesthesia? Isn’t that silly?”

“No. It’s hardly silly. It’s the ultimate question in every surgical patient’s mind. They just don’t always express it as eloquently as you did. But in your case, at least, the question’s not unanswerable.”

“It’s not?”

Jessie shook her head.

“No. Because you’re not going to be under. Sar, I went over the MRIs again. This damn thing is very close to a lot of important centers. Speech, motor, facial movements. I need you awake if I’m going to push this dissection to the limit. You’ll get a local and some sedation, but no general except in the very beginning. In exchange, I give you my word that I won’t sing during the operation.”

Sara mulled over the offer.

“No singing, huh? ... Okay, it’s a deal.”

“We’ll use continuous MRI monitoring of the procedure.”

“But not that little robot you told me about?”

Again Jessie shook her head.

“I don’t think he’d improve matters. This will be your third operation. There’s a sort of scar-tissue superhighway right down to the tumor. I can get there through the scar without causing any problems. Getting enough of the tumor so that your body’s natural defenses can take care of the rest—that’s the test. But I was always pretty good at taking tests.”

Sara reached out and took Jessie’s hand.

“My chances this time?”

Jessie pondered the question with solemnity.

“That depends,” she said finally. “Have you been giving generously when the plate’s been passed around?”

“Of course.”

“In that case, I think we’re in good shape. I’m a pretty experienced surgeon, and God only knows you’re a damned experienced patient. Together with the power of your offerings to the church, I don’t see how we can miss.”

“What if I said I never give anything when that plate comes around?”

Jessie squeezed her hand and smiled.

“I’d still tell you we were okay ... because
I
give—every chance I get. You can’t be too careful in this neurosurgical business, you know.”

SURGICAL SEVEN, LIKE the floors below it, was a broad circle, serviced by a bank of four elevators and one stairway. The nurses’ station and supply rooms occupied most of a central core, along with the kitchen, conference room, and two examining rooms. Near the elevators was the six-bed neurosurgical ICU. Around the core, with views ranging from neighborhood rooftops to urban vistas, were thirty patients’ rooms, with a total capacity of fifty. The circular hallway between the core and the rooms was known—especially by the nurses—as the Track.

In addition to the elevators and main stairway, a narrow auxiliary staircase joined Surgical Seven with Surgical Eight, which housed the neurosurgical operating rooms and recovery room. Because of shielding requirements and the massive weight of the superconducting magnet, the MRI operating room was in the subbasement, hewn into the surrounding rock.

The offices of the neurosurgical faculty, including Jessie’s, were spaced along a broad corridor that extended west from the elevators and connected Surgical Seven with the main hospital. The corridor, lined with black, spoke-back Harvard chairs, also doubled as the waiting area for outpatients.

Suddenly bleary, Jessie promised Emily she’d be back to finish rounds in twenty minutes or so and headed to her office. What the tension-filled hours with ARTIE in the OR had started, the session with Sara Devereau seemed to have finished off. She badly needed time alone.

“Contrary to what you might have been led to believe, gender does matter in our business. The two most powerful influences—one positive, one negative—that will define you as a physician will both be that you’re a woman.”

The words were Narda Woolard’s, a med school professor of surgery, and a role model for Jessie from the day they met. Rather than trying to convince female med students to ignore issues of gender when competing with men for university appointments and other positions, Woolard ran a seminar on how to capitalize on them.

“The deep sensitivity and empathy intrinsic to most women will make you that much better a physician regardless of the specialty you choose. But those same qualities will make medicine harder on you than on most men ... especially if you choose a specialty like oncology, or critical care, or certain branches of surgery, where a fair percentage of your patients are going to suffer and die in spite of everything you can do for them.”

Jessie’s office was a lilliputian, one-window cubicle, made to feel even smaller by dark cherry paneling. A desk, two chairs, a locked filing cabinet for patient records and journal articles, and a set of shoulder-to-ceiling bookshelves on one wall all but filled the room, although she had managed to personalize the space with a couple of small watercolors, some framed photos from her rafting trip down the Colorado, and a planter.

Narda Woolard’s words were echoing in Jessie’s head as she sank into her chair. She did five uninspired minutes of Tetris and set a timer for fifteen minutes. Then she put her feet up on the desk, leaned back, and closed her eyes. Usually even fifteen minutes was long enough for her to drift off, enter some sort of REM sleep, and awaken rejuvenated. This time, her thoughts refused to slow. Early on in her internship, a cynical resident, already in advanced burnout, first exposed her to what he called Fox’s Immutable Laws of Medicine:
Good guys get cancer. Trash survives
. Who Fox was, the resident never explained. But Jessie had seen the laws hold too many times ever to ignore them. And Sara Devereau was an exceedingly good guy.

Could Sara have been cured by a properly aggressive initial operation? Jessie had wondered this many times. Had Carl Gilbride even given the case much thought? How would he have felt if he had been to Sara’s house? Met her husband? Her kids? Would he have spent an extra hour or two at the operating table? Gone after those few extra tumor cells? Fat chance. Throughout her experience with the man, Jessie had never heard him admit to so much as a shortcoming, let alone an actual mistake—and there had been many over the years. ...

What difference does it make now, anyway?
Tomorrow morning Sara would have her last shot at a surgical miracle. The envelope was going to have to be pushed and pushed some more. Walking, sight, arm use, speech ... there was no telling what would have to be risked—even sacrificed—in the interest of getting all the tumor. And there was no predicting what was going to be left of Sara after the operation was done.

Go to hell, Fox, whoever you are!

“Jess?”

Emily had opened the office door and was peering in. Jessie realized that she’d been out cold, tilted back in her chair, orbiting Neptune. Her timer, which she had apparently shut off, was clutched tightly in her lap. Forty-five minutes had passed.

“Whoa,” she said, shaking the cobwebs loose, brushing some wisps of hair away from her eyes, and fumbling for her glasses on the desk. “I don’t think we’re in Kansas anymore, Toto.”

“You okay?”

“Let’s just say I needed the rest.”

“I’m glad you got some. Ready to finish rounds?”

“I am.”

“It shouldn’t take too long. Oh, before I forget, there was a call for you at the nurses’ station just a little while ago from Dr. Mark Naehring.”

“The shrink?”

“Exactly. Remember that show he put on at grand rounds?”

“Who could forget it? That poor woman.”

Naehring was a psychopharmacologist. In front of an amphitheater filled with two hundred or so physicians and other practitioners, he had used a combination of drugs to rapidly and very effectively hypnotize a middle-aged woman with profound emotional illness. He then extracted, for the first time, a terrifyingly vivid description of childhood sexual abuse at the hands of her father and his brother, at times both at once. Naehring then used more medication and posthypnotic suggestion to remove all memory of his patient having shared anything. He would introduce her revelations gradually in their therapy sessions, making use of a video where needed.