Perfect Killer (17 page)

I shook my head. Freedman got up quickly and helped me sag into his chair. We remained like that as I struggled to calm my breathing. Finally, I regained control, took a deep breath, and let it out slowly.

"Can you pull up the recent EEG and PET?"
"Sure." Freedman leaned over the keyboard and brought the scans on-screen. "Here." I tapped at the monitor. "And here ... while higher brain functions are

increasing, there's no change in the activity of the lower brain and brain stem. Remember that MRI of the ventral part of the rostral pons?" As my horror grew, I struggled to keep my focus on presenting Camilla like a grand rounds patient.

"Okay, now look over here, and there's clear evidence of recovery of higher brain function, especially in areas associated with awareness and consciousness."
"So this patient is coming out of the coma?"
"It appears so."
"Induced by the fever or the bacterial infection?"
I nodded dully at the implications.
"That's good."
"Maybe," I said.
Tyrone started to ask another question, I stopped him with a raised index finger as I grabbed my cell phone and hit Jeff Flowers's speed dial. I turned to Tyrone as the phone rang.
"The scan patterns are a variation on what is known as locked-in syndrome."
"Locked in?"
"Usually from auto accident trauma and strokes, sometimes by pontine lesions, which damage specific portions of the lower brain and brain stem while leaving little or no damage to the upper brain."
Flowers answered.
"Jeff, it's Brad Stone," I said urgently. "We may have a situation."
"Let me get to a place where I can talk," he replied.
As I waited, I pointed at the MRI image on the monitor display. "Look closely at this area and the pattern of hypodensity where the tissue has been destroyed. The pattern of damage leads to quadriplegia and, depending on the extent of damage, easily leads to death without artificial ventilation. This patient's death—ah, case, I mean—did not require ventilation, but all voluntary muscle function was lost as well as higher brain functions— until yesterday."
Flowers's voice came hack on the line. "Sorry, Brad, I was in a staff meeting.
"Thanks for taking the call. Look, Jeff, I think we have a case of locked-in syndrome developing."
"Dear God."
"Yeah. Can you do some tests to make sure."
"Anything you need."
"Thanks. As you may remember, a lot, if not most, people with locked-in syndrome retain some small degree of voluntary control over eye movement or eyelid function. We know Camilla has had neither of those. We need to determine if that's changed. Additionally, we need a functional PET to determine if she's experiencing sensory perceptions—vision, hearing, touch—the whole gamut."
Any specific tests or protocol?"
"You pick it. We need to know whether she is aware and conscious even if she is unable to communicate."
Flowers's breath caught, echoing my own of a few minutes ago. "I never imagined in my worst nightmare it could come to this."
"I know the feeling."
"Okay. I'm on it now. Should I call you back on your cell?"
"Uh-huh. And could you upload the new scans as soon as you can." I explained my ability to retrieve them. "If for some reason you can't get hold of me, you can call Dr. Tyrone Freedman here at Greenwood Hospital." I read the number and extension off the phone. Tyrone also offered his cell number, which I passed along before ringing off.
"This is really deep," Freedman said.
I turned slowly and looked up at Freedman. "People with locked-in syndrome usually retain their ability to see, hear, feel emotions, understand spoken language, analyze complex thoughts—everything cognitively and emotionally, but all the wiring to their muscles that allows them to interact with their environment doesn't work. I'm terrified this patient's consciousness has awakened inside a black void without sight, sound, or other senses, perhaps feeling pain without any ability to express the feeling or do anything to decrease it. Something like being buried alive, but without the compassion of death to look forward to."
"Oh, man." Freedman's voice was dull, flat, and low as the implications played across his face. "I imagine hell would be a lot like that."
He opened his mouth, but before he spoke, his pager went off. He plucked it off his belt.
"Oh, great," he said as he read the text message. "All hands on deck. We've got all our ambulances filled with incoming gunshot wounds, but we don't usually staff up until after it's dark."
He turned and headed for the far end of the narrow, cramped room. "We can use all the help we can get," he said. "If you're up for it, follow me to the scrub room and I'll introduce you to the chief."
I rushed along behind him.
The wail of approaching sirens quickly disappeared beneath the urgent conversations in the scrub room. Freedman introduced me to trauma unit chief Clifford Scarborough, a tall, dark-haired man built like an NFL linebacker.
"I've read some of your stuff," Scarborough said as we soaped up to our elbows. "We're likely to have head wounds."
"I'm up for it."
"Good. It's been a bad day for serious trauma," Scarborough said. "Normally, we stabilize the most serious and chopper them down to University Med Center in Jackson, but the whole damn region's had a rash of incidents. There's not a free helicopter available. You may need to do more than help me get these people ready to ship."
"Whatever I can do."
"Okay then, suit up." He pointed toward a pile of fresh folded scrubs.
I changed, and scrubbed at my hands, forearms, and elbows. I had my gloves on by the time the triage nurse stuck her head in and said she had two she thought were DOA and six more in a hurry to get there. I took a full-face splatter shield from the scrub room nurse and adjusted it to my head as I pushed through the double doors leading to the emergency room.
The corridor beyond was packed with police and paramedics. Along the wall, two young men lay on gurneys: tall, heavily muscled, and way too young to be so completely inert. Blood dripped significantly onto the tiled floor. Uniforms filled the corridor with a blue hover as police and EMTs in latex gloves moved among their charges, working to keep more life from leaking out and on guard for violence and escape.
The doors by the ambulance dock exploded inward with two more gurneys, followed by Jasmine in a white silk blouse blossoming red with fresh blood, which covered her face and arms and matted her hair.

Thirty-eight thousand feet over the unremarkable topography of South Dakota, Braxton's chartered 737 anonymously sketched contrails on a cornflower sky. In the front of the aircraft, tousled and rumpled reporters slumped in the forward seats and spoke wearily among themselves. The predawn takeoff from Reagan National and the three lightning-quick campaign stops in Buffalo, Duluth, and Fargo had exacted their toll.

At the rear of the aircraft in the off-limits area outside the General's private compartment, Daniel Gabriel looked down at the towering storm clouds and chaffed at putting "retired" after the
lieutenant general
in his title.

He had devoted his life to the Army. His only marriage had lasted less than a year when his wife realized the military was a mistress with which she could not compete. Now, with his retirement papers grinding through the DOD bureaucracy, the change in his life gathered like the same thunderstorms assembling themselves over the prairie below.

"Retirement getting to you?" Gabriel turned as Braxton settled into a seat across the aisle. "Yes, it disturbed me as well, for months."
Gabriel felt half-dressed under Braxton's gaze.
"Yes, sir," Gabriel said. "That's most of it."
"I thought so." The General paused. "What's the rest of it?"
Gabriel looked back out the window for a thoughtful moment before returning his gaze to Braxton.
"When I was making some last rounds at the Pentagon, I paid a visit to Laura LaHaye."
"I know."
"Well, sir, I'm, uh"—Gabriel searched for the correct word—"not entirely comfortable with all the implications of the Enduring Valor project."
"What bothers you most?"
"The disclosure part, mostly I suppose."
"Disclosure?"
"To the men. The soldiers." Gabriel searched Braxton's face for a clue, but found nothing there but encouragement. "Doesn't giving them medication without telling them leave us open to charges we're performing medical experiments on people without their informed consent?"
Braxton nodded slowly "Dan, we have a life-and-death struggle to make sure our forces win every battle. If we had to have a public debate on every damned thing we do, getting a signed disclosure on every damn vitamin formula we hand out to the troops, we'd never get anything done, and whatever we accomplished would be out there for all our enemies to copy. Informed consent works fine for civilians, but when it comes to war, it would only cost the lives of a lot of brave men and women."
"But—"
"But nothing. Look, do you suppose we're telling everybody the nerve-gas antidotes we pass out contain a lot more than atropine? Or that MREs in a combat zone contain top-secret formulations designed to get the best possible performance from our boys? Which is why we don't sell those particular formulations to the public."
Gabriel nodded. "But I understand Enduring Valor has a history of side effects."
Braxton's face tightened for a single frame of reality, then smoothed out so fast Gabriel didn't really see it happen; it still made him anxious.
"Side effects?" Braxton said. "I can tell you about side effects." His hand traced the famous scar on his face. "Before God gave me this, artillery fire made me urinate on myself, son. But God struck me and changed me and left a mark telling others they can triumph over their shortcomings as well. Now
that's
a side effect of being wounded, and I am grateful for it every day I get up and look at myself in the mirror"
"But, sir—"
Braxton raised his hand. "Hold on. I'm taking you somewhere with this."
Gabriel nodded.
"Frank Harper saved my life twice," Braxton said. "First on the battlefield and later in a little clinic he set up in an old POW camp in the Godforsaken swamps of the Mississippi Delta. He took a look at me then, studied me along with others who had received head wounds of one sort or another. He helped me to understand what had happened to me and explained I had apparently received the perfect wound. I received a surgical incision so precise only the hand of God could have wielded the scalpel.
"Harper studied me and tried to perfect an operation on others with head wounds that could duplicate my success. Some got better, some worse, and most were unchanged."
"Harper's work?" Gabriel ventured. "Was this some sort of official military experiment?"
"Of course not!" Braxton shook his head. "It was
treatment!
A new treatment. As hard as he tried and as many operations as he performed, Harper and his team of crack brain surgeons could never duplicate with the scalpel what God had done for me with a twisted piece of metal."
The warrior who would be president leaned back and shook his head. Gabriel saw in his face the satisfaction of being the unique success.
"That's a side effect," Braxton said again. "Harper and his people had a lot better success with the new drugs. Those
treatments
eventually inaugurated what is, today, Enduring Valor."
Anxiety coiled tighter in Gabriel's chest.
"Yes, there have been undesirable side effects in Harper's work and in Enduring Valor," Braxton conceded. "Think of it as friendly fire of another stripe."
"Friendly fire."
"My Lai. Almost the right formula, wrong dose."
"You mean My Lai—"
Braxton nodded. "We never did get formula perfected in 'Nam. Fortunately the side effects looked similar enough to Agent Orange problems that it never got picked up."
"I'm not sure I want to know these things."
"It's time." Braxton looked up at the front of the aircraft to make sure the press remained obediently out of earshot. "Time to get your feet wet, soldier, wet with things you'll need to handle as SecDef."
Gabriel's anxiety gained new weight.
"Same thing with the new drugs we used in the first Gulf War," Braxton continued. An almost perfect formula that did its job, but in a very small number of cases it caused permanent brain modifications, Gulf War syndrome, blamed it on accidental exposure to low levels of Iraqi nerve gas.
"We thought we had things worked out in Afghanistan."
Gabriel heard Braxton only distantly as his anxiety became the cuckold's shock and anger at proof of the betrayal.
"Then we had all those murders by troops who had returned from combat. Fortunately the test samples were small. But by then, LaHaye and McGovern had the right formula but realized the drug needed to be released in continuous, sustained concentrations to avoid complications. That's what our allies in Holland have perfected."
Gabriel let the drone of the aircraft wash through an emptiness in his soul he had not experienced since the death of his father.
"Son, war is for keeps," Braxton said as he laid a practiced hand on Gabriel's shoulder. "War is hell. People in American society can sustain their delicate ethical sensitivities only when people like you and me clearly grasp the reality of winning."
You and me.
Gabriel thought about this. He recognized the horrors of war, and he certainly knew the arrogant hypocrisy of the antimilitary, anti-any-war people who were willing to take advantage of freedoms that could be maintained only by the very force and establishment they defamed and despised.
You and me
.
Gabriel encountered a new line here and worried about stepping across. He wished Braxton had never told him about this. The knowledge burned like acid, ticked like a bomb.
You and me.
The General had made good points about necessity. War was a messy ethical morass that usually rewarded action over contemplation.
You and me.
Gabriel considered resigning. Walking away before he learned any more. But he had nowhere to go, no career, no job. He had left his wife—the Army—and he had nothing, no one to rely on. The press would also have a field day with the resignation. It was something he would never live down; he'd live the rest of his life in shame.
You and me.
Perhaps the General was right. He had seen a lot more action, had needed to make more tough decisions, and had more experience weighing them all.
You and me.
Gabriel knew he had to cross the line with the General. It would just take some time to come to grips with this new reality.