Code White Part 5

A patronizing nod from Lee indicated that the FBI was satisfied with the briefing. Harry looked toward a stainless steel cart that was just then rattling through the door.

"Okay, there are flashlights, tape, screwdrivers, wrenches, and extension mirrors for anybody who doesn't have one. Take what you need and get a move on. Security staff have the area a.s.signments."

As the teams began to form and stream out, Harry motioned to Judy Wolper and Tom Beazle, his two closest adjutants on the security staff. He had worked them unrelentingly since he had arrived at Fletcher Memorial-there was so much that had to be done to bring Cerberus on line-and he had begun to feel a little friction lately, particularly from Tom, who had recently gotten married. But they were both bright-eyed and poised for action.

"Guys, I need you to do a few things for me," he said, straining his voice to be heard above the din in the room. "First, I need you to go down to Telecommunications and shut down the hospital paging system. We have a hundred pagers going off every minute around here, and I don't want to risk a stray signal setting off a bomb. Have Telecommunications send out a general e-mail saying that we have a technical problem and we're working our tus.h.i.+es off trying to get it fixed. Then call the dispatch services and have all ambulances diverted to ERs at other hospitals. We need to keep our own ER beds free, in case we do have an ... event."

Judy looked at him with a disbelieving squint. "You mean-"

"Yes, that's exactly what I mean. We can't openly evacuate, but we can d.a.m.ned well do something to lower the head count inside these buildings. Visit each of the outpatient clinics, and have them discreetly cancel as many patient appointments as they can. You don't have to tell them why. Just tell them it's a hospital emergency. Then go down to s.h.i.+pping and receiving and call off any nonessential deliveries."

"This is serious, isn't it?"

"Yes ... Yes, it's serious." Looking into her eyes, he realized that a single wrong word could turn her steadfastness into panic. He had to focus her on the job at hand, not the danger. "We can handle this, Judy," he said, stooping a little to make direct eye contact. "We trained for it. We drilled it. Let's just do our job and go home for dinner."

Dr. Helvelius had said no more about the annoying Mr. White. After an hour of painstaking dissection, he had mobilized the AVM enough to have a glimpse of its underside, where the main feeder arteries were found. He first encountered a web of small arteries, most of them no thicker than a pin, which he sealed easily, one by one, with the bipolar cauterizer. Behind these were the really large arteries. Metallic clips had to be placed on these, in places where the artery wall was of normal thickness, and not ballooned out, because if the clip worked free at any time down the road, the result would be an instantaneously fatal hemorrhage. Last of all was the single draining vein that Dr. Helvelius had purposely left open, but which he now clipped and cut, like an umbilical cord, allowing him to lift out the AVM in a single piece.

"Irrigation, please." Ali flushed the cavity of raw brain tissue with a gentle stream of saline. By pressing a b.u.t.ton on the irrigator, she was able to suction off the blood-tinged water, revealing the pinkish-white surface of living, thinking tissue underneath.

"Could we focus that lamp a little?"

A nurse reached up and adjusted the lamp using the plastic-shrouded handle in its center. Dr. Helvelius studied the cavity for any sign of oozing of blood. Once or twice he dabbed at it with the cauterizer, and Ali, without the need for prompting, followed each dab with another round of irrigation and suction.

As she stood by patiently, Ali thought of the first time she had watched Helvelius operate. Back then, those eyebrows bristling over the rim of his eyegla.s.ses had been black, not gray. His nine-fingered hands had been just as sure and unerring. The case was a schwannoma, a tough, stringy tumor that had wormed its way through the ear ca.n.a.l to the very base of the patient's brain. Helvelius operated for six hours, standing in one spot the whole time, without taking a break to eat, or drink or answer nature's call. Ali had wondered at his discipline. She had never known a man so completely the master of himself. He was nothing like those surgeons who grew tense in the operating room, who shouted at nurses and threw instruments. His spirit was gentle and light-hearted. With scalpel in hand, he became the scalpel. Helvelius himself ceased to exist.

And from that very first day, Ali coveted his secret. She, too, yearned to cease to exist. She knew that neurosurgery was a man's domain. Fewer than one in twenty in its ranks were women. To climb up the pyramid, she had to work twice as hard as any other surgical intern, sleep half as much, starve herself, endure every indignity, and never, ever lose her temper or complain. Six years of residency, two years of fellows.h.i.+p, three years of research-all to become acolyte to this Sufi, this mystic healer, who knew how to lose himself in his art. The payoffs were rare. But there were days when, for a few s.h.i.+ning moments, she felt as though she had received from his hands the gift of finding peace through detachment, and of escaping from the relentless self-doubt that haunted her.

Eleven years together, and in all that time, she had never once thought of Helvelius as a lover. To her, he had been scarcely a physical being at all. Divorced, childless, he seemed content with his solitary life. Surgery was his only pa.s.sion. But there came a day when she learned to see him in a different light. It was just after she had left Kevin. She was in surgery, holding a retractor, when suddenly, without warning, she found herself paralyzed by thoughts of loneliness and guilt. She didn't cry out. She couldn't make a sound or even let go of the retractor. She simply stood there, for minute after stock-stupid humiliating minute, with tears streaming down her face. The nurses and resident surgeons gaped in astonishment. She expected to be thrown out of the operating room. But Helvelius went on with the operation as though nothing had happened.

That evening, he insisted on driving her home to the studio apartment she had taken in the seedy University Village neighborhood by the medical center. It was the first time he had ever been to the place where she lived-in fact, the first time they had ever been together anywhere outside the hospital or a conference hall. He had her lie down on her sofa while he made dinner. She remembered well what he made-chicken pan-fried in olive oil with capers, a small salad, a side dish of asparagus. It took him no more than twenty minutes to make it. They ate at a small table with folding wings.

Over dinner, Helvelius sat without comment while Ali groped to explain her lapse in the OR and her troubles over Kevin. When her words dried up, he took her by the hand. "Don't be embarra.s.sed about today," he said. "I, too, know what loneliness is."

And with these words, Richard Helvelius had ceased to be a paragon, and became a man.

They were not physically intimate for some time. At first, they simply met after hours for dinner, and then talked and listened to music. When intimacy came, it was natural and unpretentious. It was not like her unions with Kevin, where matter annihilated antimatter in a cosmic upheaval. With Helvelius, s.e.x was a sanctuary. She came away from his bed feeling a little more whole, and a little less vulnerable to the perils of her disordered life.

He treated her like a newly discovered jewel, taking her to the Lyric Opera and to his favorite restaurants on the Magnificent Mile. But she especially cherished the weekend getaways to his lake house in Wisconsin, where he taught her to pilot his small day yacht. Watching the boat's wake spreading silently over the water, or the moonlight s.h.i.+mmering on the silvery waves, she could almost forget Kevin's face haunting her. At night, they would lie together in front of the crackling fireplace, and she would play with the gray curls of his lean and still-muscular chest, often scarcely speaking until the last embers had gone out. She didn't ask where the relations.h.i.+p was headed. She had stopped thinking about tomorrow altogether-something quite unusual for her, who had always fretted over the future as a thing to be dreaded if it could not be controlled. She began to see things she had long overlooked, little things like clouds, pebbles, whirling maple keys, or the way pigeons c.o.c.ked their heads when they walked. She rediscovered the aroma of fresh waffles in the morning, the softness of a blanket around her shoulders at night. It was all so new to her. Would it last? She didn't know. But she was closer to being happy than she had been in years.

Helvelius stepped back from the operating table. "Okay, I think I'm done. Let's get one last angio."

The table of operating instruments was rolled away, and the C-arm of the X-ray machine moved into its place. Once again, the room was cleared, and films were made from several angles.

"Looks clean to me," said Helvelius as he perused the films. "What does Odin say?"

The room was filled at once with Odin's silvery baritone. "I'VE USED ALL THREE PROJECTIONS TO RECONSTRUCT A THREE-DIMENSIONAL TOMOGRAPHIC IMAGE. COMPARISON WITH TODAY'S PRE-OPERATIVE SCAN SHOWS NO VESSELS OF ABNORMAL CALIBER OR CONFIGURATION, AND NO RESIDUAL BLOOD FLOW IN THE REGION OF THE AVM. PERFUSION TO NORMAL BRAIN IS INTACT."

"Then all is well?"

"YES, DR. HELVELIUS. THE RESECTION IS COMPLETE."

"Very well. Dr. O'Day, the patient is all yours."

Ali took a deep breath. She felt a nervousness that was rare for her in the operating room. The eyes of everyone were upon her. Everything-the AVM resection, the cameras, the tables filled with s.h.i.+ning instruments-everything had been a preparation for this moment. It was a responsibility that could crush her if the smallest detail went wrong.

"Kevin," she said quietly, "is SIPNI ready?"

Kevin turned and held an induction probe, shaped like an oversized lollipop, over the blue sterilization wrapper on the table. "Odin, I'd like a last-minute functional status check of the SIPNI device."

"PRIMARY CIRCUITS ARE OPERATIONAL, KEVIN, WITH NO MORE THAN 0.005 PERCENT VARIATION IN IMPEDANCE AND IN THE PREDICTED TWO-WAY SIGNAL TRANSIT TIME. THESE PARAMETERS HAVE BEEN DETERMINED, OF COURSE, AT ROOM TEMPERATURE. A VARIATION OF AS MUCH AS 0.007 PERCENT IS POSSIBLE AT 37 DEGREES CELSIUS."

"Almost too good to be true."

"I'M SORRY, KEVIN. WOULD YOU LIKE ME TO REPEAT THE STATUS CHECK?"

"No, Odin. Just joking. I'm sure we can live with those parameters." Kevin turned to Ali. "You're on," he said.

The circulating nurse picked up the sterilizer bag and tore it open, allowing the device itself to fall onto the instrument tray. It looked like a jeweled egg, its finely faceted surface glinting both gold and silver. As Ali cradled it in her hand, she wondered at how small it now seemed. Was this the end product of all the thousands of hours of work, the millions of dollars, the debates, the midnight brainstorms, the endless succession of victories and defeats of the past three years? Was this what she had lived for?

Carefully, as though it were alive, Ali began to paint the outside of the egg with the precious gel called CHARM. She painted two coats, slowly turning the device in her palm. Refracted through the faintly violet-colored gel, the SIPNI device s.h.i.+mmered, like a polished amethyst.

As she slipped it into its setting, deep in the pocket inside Jamie's brain, Ali was almost reluctant to let it go. She used a scissors-shaped Olsen-Hegar suture holder to anchor SIPNI with two st.i.tches to the tentorium cerebelli, a tough membrane that supported the hindmost part of the brain. Then she unlocked the retractors, watching as the wrinkled surface of the brain slid back into place, and the SIPNI device could be seen no more. There it is, she thought. History's been made. Quickly, with long-honed and almost automatic movements, Ali replaced the flap of the skull and sewed Jamie's scalp shut, leaving the edges of the skin a little everted, so that they would heal cleanly in the purifying air. She stood motionless, still holding the Olsen-Hegar in her hand, long after the nurse had cut the last suture thread.

"Everything all right, Dr. O'Day?" asked Helvelius.

In the background, the gradual Haec dies quam fecit dominus was playing.

"Yes, I'm fine. Just ... just thinking." Yes, thinking what everyone in the room was thinking, only no one had the courage to say. Have we not crossed a terrible threshold? Where will it lead? If man has found the power to re-create himself, in whose image will he be re-created?

"Let's charge 'er up," said Helvelius.

Ali stepped back to make way, but Helvelius waved her toward the table. "No, you do the honors."

The nurse presented her with something shaped like a large, flexible horseshoe wrapped in plastic. She spread the ends open a little, and positioned them against the base of Jamie's skull, at the same level as the old AVM cavity.

"Okay. Switch it on."

"Power is on," said Kevin.

Dr. Helvelius turned toward the TV camera. "Right now we're charging up the SIPNI device, using a magnetic induction coil, similar to what you would use to charge an electric toothbrush or a laptop computer. Once it's charged, SIPNI will immediately go to work, sending out pulses that will seek out and form connections with what we call the optic radiations. Those are remnants of the visual processing cells that originally fed signals from Jamie's eyes to the lost part of his brain. It will be awhile, of course, before we see any results from that."

For several minutes, the room was quiet, but for the hiss of the bellows of the anesthesia machine, and the occasional beep of the IV pump. At last, Kevin O'Day called out, "SIPNI is at full power."

"What's the EEG show?" asked Helvelius.

From behind the blue curtain came the voice of the anesthetist. "Signature electrical activity in the occipital lobe, about thirty-five megahertz. I believe that's within the calculated norm."

"We're done, then. Let's turn him over."

Someone switched off the CD player in the midst of a descant on exultemus et laetemur.

The two surgeons and two nurses lifted Jamie and turned him onto his back, taking care not to entangle the IV lines and wire leads that seemed to spring from every part of his body. The anesthetist turned down the nitrous oxide gas. As soon as Jamie showed signs of eye movement, the anesthetist pulled the soft plastic breathing tube out from Jamie's throat. As it came out, dripping secretions, Jamie began to cough.

"That's good, Jamie," said the anesthetist. "Give us a nice cough."

Still semiconscious, Jamie coughed two or three times. A gurney was rolled in, and a white plastic board was slipped under Jamie's back to help lift him from the operating table. Once he was on the gurney, and the IV bags had been rehung and a portable monitor attached, Ali and Florinda wheeled him out of the operating room, past the scrub sinks, and toward the recovery room down the hall. They parked the gurney in a bay just inside the entrance. Ali lent a hand while Florinda and one of the recovery room nurses hooked Jamie up to a regular telemetry monitor and fastened an oxygen line under his nose.

"Let's give him five liters of oxygen for now," said Ali. "His sats are just a little bit low."

The adjustment was made, and Florinda returned to Operating Room Three. Ali stayed behind for a few minutes, writing orders into Jamie's chart and going over them verbally with the recovery room staff. It was important that everything be followed to the letter.

Ali made a last check at the bedside. Jamie was sleeping comfortably. His vital signs were good. The EEG showed some theta waves and occasional bursts of sleep spindles-all indicative of a smooth recovery. She touched her fingers to her young patient's cheek, and then turned and headed into the hall.

"Don't you think that nurse looks like your sister Josie?" said the gray-haired woman lying in the hospital bed. The pale skin of her face had a puffy waxiness to it that filled out all the small wrinkles and made it hard to guess her age. Because of a plastic oxygen tube fitted to her nostrils, her voice had an uncharacteristic nasal sound.

Harry Lewton was sitting in a plastic chair beside her, his legs sprawled wide. He had just finished a walk-through of the hospital, and he was feeling frustrated. So far, the search teams had come up with exactly one dead rat in a crawl s.p.a.ce and one homeless guy trying to sleep off a pint behind a Dumpster.

"Momma, it doesn't matter what she looks like," he said. "Just so she takes good care of you." Up north, he had worked hard to play down his East Texas accent, but in his mother's presence it had a way of creeping up on him.

"Stop fussing over me, Harry. I think you've got all these people on pins and needles on account of me."

Harry winked. "Don't worry. It does 'em good."

"Oh, Harry!" she said. "Can't you ever stop worryin' about other people? Twenty years ago, when you were fifteen, it was different. You were a G.o.dsend then, stepping in to help raise your little brother and sisters, after that no-account daddy of yours got drunk on the job and hurt his back and decided to live the rest of his life on a pittance of disability checks. I can't thank you enough for it. But I'm your momma, and I never asked you to take care of me. I always could look after myself."

"It's nothin'. It was nothin' then, and it's nothin' now."

"Hogwas.h.!.+ You got them kids dressed, gave 'em breakfast and made 'em lunches every day of the week, so's I could leave at five-thirty to go drive that bus. And then, after school, you stuffed bags at Kroger's Market till after dark, just so we could have a decent supper on the table. You call that nothing?"

"h.e.l.l, Momma. If I'd've had idle time on my hands, I'd have wound up in the Dixie Popes or one of those other neighborhood gangs. I liked b.u.mpin' my knuckles too much."

"But it cost you your childhood, Harry. I look back, and I am ashamed of it."

"This is no time to talk about things like that."

"No, Harry, it's exactly the time."

"It wasn't your fault. Let the shame be on him that's dead and buried. Enough said."

It was hard for Harry to look upon his mother's face. It had taken on a lifeless, unchanging masklike quality that made her seem like a stranger, and not the vibrant, chestnut-haired beauty he remembered. He got a knot in his stomach thinking of her, back in the days when folks called her "Sugarfoot" for the mean figure she cut on the line-dance floor. Now she needed help just to blow her nose. How does she hang on like that? he wondered. How does she face the day?

He knew how. She had the quality known in East Texas as grit, and she had it in spades. There was no other way the family could have lasted. Grit could be toughness, sometimes, and at other times tenderness. But what it meant was you could not be beaten down. Harry remembered one night when he was five or six, and he had sat up in bed shaking after his daddy smashed the TV set in one of his drunken rants. Momma heard him crying, and came to his room carrying a gla.s.s of milk and a beat-up old p.a.w.n-shop guitar. In her honey-and-mola.s.ses voice, she sang to him an old Pentecostal song that had been made famous by the Carter family: Keep on the sunny side, always on the sunny side, Keep on the sunny side of life It will help us every day, it will brighten all the way If we'll keep on the sunny side of life.

A simple song, but it had the power to dry away his tears that night. It defined his momma the way he had always known her. And his heart ached to think of it now.

Harry heard the step of a hard leather shoe on the linoleum, and looked up to see a balding, gray-haired man in a white coat come into the room.

"Morning, Dr. Weiss," said Harry. "Kind of you to drop by."

Weiss nodded curtly and went directly to the plastic chart binder that was kept in a slot at the foot of the bed. He opened the binder, scanned it briefly, and then slammed it shut.

"Still running a fever, Mrs. Lewton," the doctor announced.

"Call me Viola. After the things you've peeked into, I think we should be on first-name terms."

Weiss lifted his stethoscope from his shoulders and hooked it into his ears. As if by a prearranged signal, Harry rose out of his chair and gently lifted his mother to an upright sitting position in her bed. He watched silently as Weiss slid the stethoscope under Viola's gown and moved it around her chest and back.

"I still hear rales at the bases of the lungs," concluded Weiss, flipping the stethoscope over his shoulders.

"Rolls?" asked Viola.

"Raaahlls. It's a sound like wet velcro ripping. It means your pneumonia hasn't gotten any better. Hopefully, there'll be some improvement when the new antibiotic has had a chance to work."

Harry nodded toward the door. "Doctor Weiss, can I speak to you privately?"

"I have to be at Grand Rounds at ten," said Weiss, glancing at his watch.

"It'll only take a minute." Harry directed Weiss toward the hall. At the doorway, he stopped and turned to Viola. "Anything you need, Momma? I'm going to have to step out for a bit."

Viola shook her head.

"See you, then." Harry shut the door. Weiss had already gone ahead several paces, but stopped and looked back at Harry.

"Well?" said Weiss.

Harry said nothing until he had caught up to Weiss. Then he looked to either side, and lowered his voice confidentially. "I want to have her transferred to another hospital."

Weiss arched his eyebrows. "Are you joking?"

"Stroger, Rush, Northwestern-wherever you think best."

"Are you unhappy with her care?"

"No, not at all."

"What then? Last night you practically begged me to take her on as a patient. Why the sudden change of heart?"

"Let's just say, I have personal reasons. I want her transferred and I need it done within the hour."

The doctor winced. "That's just not possible, Mr. Lewton. Your mother isn't stable enough for transfer."

"She seems lucid."