Patient (15 page)

“What do you mean?”

“The witness in Spain, the one who told me about Malloche’s brain tumor?”

“Yes?”

“His name is Cardoza. He claims he’s seen Malloche—several times. He looked at all the photos I showed him, but refused to say whether any of them was or wasn’t Malloche. He wanted to cut a deal for passage for him and his family out of Spain, and enough money to set them up wherever they went.”

“Why didn’t you make the deal?”

“How could I trust him? He was still in prison. He could have pointed out anyone.”

“But now you trust him?”

“I do. Apparently Malloche found out Cardoza had been speaking with us. A few weeks ago, his apartment was blown up. As I said, he was locked up, but his wife and kid weren’t so lucky. The police in Madrid have him someplace safe for now, and they’re moving him around. But Malloche has money to burn, so it’s only a matter of time before someone on the force takes a bite and sells Cardoza out. They offered to take him out of the country for the time being, but he refused. He wants Malloche dead.”

“What about the photos, then?”

“A dozen or so nos, one maybe. That’s the best he could do. The maybe is so blurred that it could be anyone. As soon as I have a suspect, Cardoza’ll be flown over.”

“This is just crazy. You’re working this case all by yourself?”

“I have a little help from the local FBI. Not much, but a little.”

“So who killed Cardoza’s wife and child?”

“What?”

“If this Malloche is as good as you say at killing, it’s a little hard to believe he hasn’t killed Cardoza as well. And if this whole phantasmagorical story of yours is true, it would seem you had quite a bit to gain from blowing up that family in Madrid yourself.”

Bishop’s look held genuine admiration.

“You know,” he said, “the truth is, if I had thought of doing it, I very possibly might have. But I didn’t.”

“Killing an innocent woman and a child?” Jessie said. “How noble.”

“I told you I didn’t do it,” Bishop replied, “but I also told you how much getting Malloche means—how many lives his capture or death will save.”

“Well, either way, I don’t see how I could possibly be of any—” Jessie felt a sudden chill. She took several deep breaths through her nose, trying to maintain some composure. “Alex, or whatever your name is, tell me something. That car trouble you saved me from, was that rigged?”

There was the briefest hesitation, during which Jessie was certain Bishop was mulling over whether or not to lie.

“I ... Jessie, I was desperate to learn about Gilbride,” he said. “I needed to get inside the neurosurgical service quickly. From what I could tell, he wasn’t someone I could trust. You were. I had to get close to you.”

“Jesus.”

“I’m sorry. I really am. Jessie, I admit the way I met you and some of what I told you about myself was contrived, but none of what I’ve told you tonight has been. I’m sorry I had to lie, but I need your help. I’m
begging
you to help.”

“Get out!”

Bishop stood.

“Jessie—”

Jessie leaped around the edge of the desk and punched him viciously on the side of his face. Then she pushed the photos at him. He clutched them clumsily against his chest and backed into the hall.

“Alex?” she said less stridently.

He took a step back into the doorway.

“Yes?”

She moved forward and slapped him, raising a crimson, palm-shaped welt on his cheek.

“I’ll think about it,” she said.

She slammed the door in his face.

Chapter 19

MIDNIGHT ... TWELVE-THIRTY ... ONE. LYING in her darkened bedroom, Jessie watched the time pass on the lighted dial of her clock radio. One-thirty ... two. She remembered a vial of sleeping pills in her medicine cabinet from some bygone era in her life. Although she hadn’t taken any in years, and they were probably expired, she seriously considered trying one or two. Finally, she picked up the novel she had been inching through at a page or two a night, and padded out to the living room couch. She was wearing her usual sleeping garb-an extra-large T-shirt, this one from Earth Day. Nothing more.

She was furious at Alex’s deception, but even more, she was angry at herself for buying into it. Fairy tales were tales—it was as simple as that. And expectations, as often as not, led to pain.

Keep your expectations in check, tend to business, and good things will come
, she told herself. Alex Bishop was nothing more than a pothole in the road of her life.

She set the book aside and tried some warm milk. Nothing was going to calm her thoughts. Gratefully, Ben Rasheed’s selling his OR time had left her with a relatively light day ahead. If she had to endure a night without sleep, so be it. She had the proven constitution to work thirty-six hours with little or no rest, although her body inevitably paid the price when she did.

Was Alex telling the truth?
she asked herself.

The photos were impressive, but they could just as easily belong to the killer as to the CIA. The sicker the man, the slicker the lies. Who said that? Maybe no one. Maybe the line was all hers. The slicker the man, the sicker the lies.

Two-thirty.

Jessie queued up a ball in Pin Bot and lost it between the flippers after just five seconds or so—a catastrophe that could have been avoided by a right-hand nudge that was usually routine for her. This simply wasn’t going to be her night for anything. She opened the novel again, read a few sentences, and then set it aside. The questions kept rumbling through her mind like tanks.

How could Alex be so certain Malloche was headed to Carl for his surgery? Was he really the dogged CIA pursuer making an expert guess based on five years of tracking down his prey, or was he one of Malloche’s people, or even Malloche himself, in the process of making up his mind about who would cut on him? If Malloche was Mr. Thorough, as Alex claimed, it only made sense that he would check up on Gilbride and the whole neurosurgical service at EMMC before letting Carl drill open his head. And what more reliable, efficient way to do that than to start up a romance with one of the surgeons in his department?

Why in the hell couldn’t it all have been real?

She rubbed at the exhaustion stinging her eyes as she again confronted the most troubling question of all: What if Alex was telling the truth? What if he
was
so set on capturing this Malloche that he would use her as he had? And even if she ever did come to trust what he was saying, could she possibly agree to help him? What about the patient/physician confidentiality she so treasured? Did it not extend to Gilbride’s patients—even to one who might be a killer?

The telephone startled her so that she sloshed some of the warm milk onto her thigh.

“Hello?”

“Jessie, it’s Alex. Please don’t hang up.”

About to do just that, Jessie kept the receiver to her ear.

“What do you want?” she asked.

“I need to talk to you.”

“No!”

“Jessie, please. Everything I told you in your office was true. Deceiving you the way I have was stupid and cruel. I’m sorry I did it. I’m under tremendous pressure, and in the world I come from almost nothing matters more than getting the job done. But it was still a dumb mistake.”

“Okay, you’ve apologized. Good night.”

“Wait!”

“Dammit, Alex, you’ve hurt me. I don’t want anything more to do with you. Now—”

“Listen, Jessie. Malloche is in your hospital right now. I’m almost certain of it. If I’m right, there’s a good chance people are going to be killed—maybe me, maybe you, maybe even some of your patients.”

Jessie sensed herself freeze at the last possibility. She felt certain Alex knew that she would.
Damn him!

“Where are you?” she asked finally.

“I ... I’m right outside. I’ve been here for a couple of hours, thinking. I had decided to leave and not try to speak with you until the morning, but then your light went on.”

“So you knew where I lived and which one was my apartment. Why am I not surprised?”

“Jessie, I’m going to get Malloche no matter what. But it would be a hell of a lot easier and maybe a lot safer for everyone with your help.”

Jessie chewed anxiously on her lip, wishing she was anyplace else.

“Ring the bell. I’ll buzz you in,” she heard herself say.

Her condo was on the third floor. There was a security camera mounted downstairs in the outer foyer. Channel Two. She switched on the TV and flipped to the channel. Alex, wearing a light windbreaker, entered the outside door and looked up at the camera as if he knew she would be watching.

The doorbell sounded. She went to her bedroom and pulled on a pair of sweatpants and a hooded sweatshirt. She then stood by the intercom box, reminding herself that, Malloche or CIA, the man she was about to allow into her apartment at two-thirty in the morning was a professional killer. The bell sounded again, and she buzzed him in. Then she opened her door and watched him trudge up to the top of the wide, carpeted stairway that had once graced a sea captain’s mansion.

“Thanks for seeing me,” he said.

Fatigue etched his face.

She motioned him to an easy chair and took a place on the end of the sofa farthest from him.

The sicker the man, the slicker the lie
, she reminded herself.

“What do you want from me?” she asked.

Bishop leaned forward.

“I’m almost certain Rolf Hermann is Claude Malloche,” he said. “In fact, I’ve contacted the people in Madrid. They’re in the process of sending Jorge Cardoza over here right now. There are many factors in favor of Hermann being Malloche, and not many against it. That wife of his is what made me suspicious of him in the first place. Although I’ve never seen her, I’ve been told that Malloche has a remarkably beautiful wife—a former recruit of his from Austria. Her name’s Arlette. Not Orlis.”

“The Countess seems pretty cold, all right,” Jessie said, “but Rolf actually seems like quite a nice man, and he barely speaks English.”

Alex laughed disdainfully.

“My bet is he can speak it and half a dozen other languages without an accent. I’ve got people in Europe trying to see if there even is a Count Rolf Hermann, but that could take time.”

“You don’t have a lot of that, I’m afraid. Hermann’s being operated on tomorrow afternoon—hell, it’s
this
afternoon now.”

Bishop looked startled.

“I thought he was on the schedule for Thursday.”

“His wife paid off one of my patients to switch. Dr. Gilbride is operating on him as the second case later today.”

“If I tip my hand and make a move on Hermann before Cardoza gets here to identify him, and I’m wrong, I’ll most likely have ruined everything. Malloche will hear about it. I don’t know how, but he will. He’ll go someplace else, and I’ll lose what is probably my last chance.”

“But you think it’s Hermann.”

“Right age, right build, right wife, right timing, European. Yes, I think it’s him. And those so-called children of his. They’re bogus. I’d bet on it. If he’s operated on today, when will he be ready to leave the hospital?”

“Assuming there are no unusual problems from the surgery, it could be anywhere from five to seven days. But this is a tough tumor. Given its location”—
and the flaws in Carl’s surgical technique
, she wanted to add, but didn’t—“there is the significant possibility, even with our robot helping with the operation, that there will be damage to some intervening structures. If that happens, he could be in the hospital much longer.”

Jessie suddenly realized that she had just crossed the line and disclosed information on a patient. If she allowed Alex to hang around her, it wouldn’t be the last time. She was either in, or she was out.

“In that case,” Alex was saying, “I’m not going to do anything that will interfere with the surgery. If I’m right about Hermann being Malloche, and if there is a God, the man will end up permanently paralyzed from his eyebrows to his toes—totally aware, but immobile forever. The perfect justice.”

“Your justice, maybe,” Jessie said. “I’d like you to go now.”

“But—”

“You’ve apologized to me, you’ve said your piece, you’ve asked me to help you. Now I’d like you to leave me alone. I told you in my office I would think about getting involved. At the moment, I’m disinclined even to speak to you anymore. If that feeling changes, you’ll hear from me.”

Their eyes met, and Jessie quickly looked away. She couldn’t stop remembering the hour after Jackie Terrell’s death—Alex’s touch, how much his caring and insight into how she was feeling had meant to her. Well, he wasn’t going to get to her again. Intellectually, she was becoming inclined to believe what he was telling her. But she was not ready to forgive the lies.

Alex stood and seemed for a moment as if he had something else to say. Then he simply shook his head in frustration.

“Thanks for listening,” he said as he left.

Chapter 20

THERE WAS AN ELECTRIC TENSION SURROUNDING the MRI operating room as one by one the players began to assemble for the robot-assisted tumor extraction on Count Rolf Hermann. Jessie stood outside the room, watching the silent, slow-motion ballet through the heavy glass observation window, and wondering if the broad-shouldered man being ministered to by the anesthesiologist was, as Alex had claimed, the ruthless, remorseless killer of hundreds.

To her right, Hans Pfeffer and the console tech were checking and rechecking their instruments. Jessie pictured the action a floor above them where, in the cluttered, space-age computer center, half a dozen geek geniuses were preparing their remarkable machines to process the imaging data sent to them by the massive MRI. Their focus throughout this operation would be not on the patient, but on the tumor and the normal structures surrounding it. In addition to Pfeffer, a Dutchman, there were scientists from Germany and Sweden, Russia and Israel and the U.S. And for the next four or five hours, the life of a man they had never laid eyes on would be in their hands.

It was well within her rights for her to watch the surgery, but Jessie still felt obligated to get Carl’s permission. Although she had spent significantly more hours than he had working ARTIE through any number of test matrices and animal models, as well as the ill-fated effort on Pete Roslanski, she felt like the understudy, asking the star if she could watch from the wings. For a few seconds, it seemed that Gilbride might actually refuse her request—surprising, given that he relished an audience for his performances.

“Well, Jessie, I certainly don’t mind you hanging around during the procedure,” he said, finally, “but with Eastman Tolliver on a riser behind me, and Skip Porter in the OR as well to keep an eye on ARTIE, I think it might be a bit crowded in the room. How about you watch the proceedings outside on the screen in the console area.”

“Actually, that’s what I was planning on doing,” she replied.

“Fine, then. I’ve gone over ARTIE most thoroughly with Skip, and both of them appear to be in perfect working order.”

He chuckled at what was, for him, a raucous joke.

“That’s great.”

“The tumor is sitting pretty for a transsphenoid approach—up the nose and in.”

“Up the nose and in,” Jessie parroted, trying to sound more enthusiastic than sarcastic.

Hermann’s meningioma was, indeed, the ideal tumor in the ideal location for ARTIE. But Jessie remained unconvinced that Gilbride—or even she herself, for that matter—was fluid enough, and comfortable enough with guiding the apparatus, to risk using it on a patient—even one who might be a remorseless killer.

It was nearly two in the afternoon of a day that had started clear and sunny, but had clouded over by noon. Jessie estimated she had slept at most for an hour and a half, just before dawn. For once, she was glad she was not the one operating.

Skip Porter entered the console area from the scrub room, waved a dripping hand at Jessie, and backed into the operating room to be toweled off, gowned, and gloved by the scrub nurse. He was tall, gangly, and refreshingly free of ambition, with bleached blond hair and a ragged goatee that reminded Jessie of Shaggy in
Scooby Doo
. He also had a commitment to perfection in his work, and a practical understanding of electro-mechanics that rivaled any Jessie had encountered at MIT. If Skip was nervous about his second case with ARTIE and Gilbride, he hid it well. His report to Jessie on the Marci Sheprow surgery was that both robot and surgeon had performed admirably, and that the tumor dissection, however straightforward, had been flawless. But he knew, as did Jessie, that Rolf Hermann’s complex meningioma presented an infinitely greater challenge.

ARTIE-2 was sterilized and covered on a steel tray. Porter would check it out one final time as he attached it to the port next to the guidance panel where Gilbride would be working.

There were seven in the OR now: the scrub and circulating nurses, anesthesiologist Pramod Sanjay, a med student rotating through Sanjay’s service, a neurosurgical resident from Ghana named Danl Toomei, who would be Gilbride’s assistant, Skip, and of course, the patient. Next to arrive was Eastman Tolliver, looking fit and trim in his sky blue scrubs. His eyes smiled at Jessie from above his mask as he came over to shake her hand before entering the OR.

“I must say, this is all very exciting,” he said.

“Yes, it is,” she replied, “although I’m not sure Count Hermann would share our enthusiasm.”

She nodded at the scene through the window, where the anesthesiologist was sliding Rolf Hermann through the central opening of the MRI and into position between the huge tori, where his head could be bolted to the circular immobilization frame.

“Quite a remarkable scene,” Tolliver said. “Most impressive.”

Carl would be pleased to hear you say that
, Jessie thought.

“I’ve been down here dozens and dozens of times as observer
and
surgeon, and it still amazes me,” she said. “To someone who hasn’t seen it before, it must be like landing on another planet.”

“Perfectly put. I’m very excited. Well, I guess I’d better get in there.”

“You’ll have the best view looking over Carl’s right shoulder. That way you can watch the patient, the control panel for ARTIE, Dr. Gilbride’s hands, and the MRI screen.”

“Excellent. That’s where I’ll set up, then.” He looked through the observation window and added, “I’m going to say a prayer for that poor man.”

And I’ll say one for Carl.

“In the OR, prayer is always a good idea.”

Tolliver lingered for a few more seconds and then entered the operating room.

Eight in. Moments later, with the arrival of a translator, there were nine. One to go. The crowd around the console outside the OR had swelled as well. Danl Toomei’s back was about all anyone could see through the observation window, so most were clustered near the twin screens—one projecting the surgical field from an overhead camera, and the other displaying a duplicate of the images being transmitted to Gilbride and his assistant from the computer center.

Surgical theater at its best, Jessie thought. Hog heaven for Carl Gilbride.

Moments before Gilbride made his appearance, Jessie’s attention was drawn through the crowd to the safe area—the area thirty feet or so from the OR door, beyond which scrubs did not have to be worn. Alex Bishop was there in his hospital security uniform, leaning casually against a thick, concrete-covered support pillar. There was nothing casual, though, in his eyes or in the set of the muscles of his face. He was alternating between scanning the observers and peering as best as he could manage through the window into the OR.

His gaze connected with hers, and he nodded briefly. She returned the gesture and then shrugged her bewilderment at the whole deal.

Where’s the truth, Alex?
she wondered.
Where’s the truth?

For a time the images of bodies arranged in a grotesque tableau, with bullet holes in their foreheads, occupied her thoughts. Her unpleasant reverie ended abruptly when, hands up, palms in, dramatically banging the scrub room door into the wall as he backed through it, Carl Gilbride crossed before the multitude and entered the OR.

Let the games begin
, Jessie thought as Gilbride was quickly gowned and gloved. Having seen his often rushed and awkward technique in the OR, Jessie realized that ARTIE, with its meticulous, microscopic abilities, might well represent an improvement.

She scanned the two monitor screens. The operative field was prepped and ready. The color-enhanced image of Hermann’s brain tumor, displayed by the crew upstairs, had excellent resolution. At the moment, normal brain tissue was navy blue, and the meningioma canary yellow. Blood vessels, appropriately, were crimson. On the other side of the observation window, all the principals were in position. Although Gilbride was largely screened from her by the resident, Jessie could see Eastman Tolliver on an eight-inch riser, watching intently from over Carl’s right shoulder.

A four-million-dollar grant ... Claude Malloche ... Count Rolf Hermann ... Alex Bishop ... so much was riding on the next few hours.

“Ready, Dr. Sanjay?” Gilbride asked.

“No problems,” the anesthesiologist said.

“Dr. Toomei?”

“Ready, sir.”

“Mrs. Duncan?”

“All set,” the scrub nurse replied.

“Dr. Pfeffer?”

“At your command, sir,” the radiologist called out.

“Well, then, scalpel and periosteal elevator, please.”

The approach to getting ARTIE into place was straightforward. With the Count fully asleep, a probe would be inserted through a small incision up one nostril, and a half-inch hole would be drilled through the skull where the bone was thinnest. A fine guide wire would be fed in through the opening, and ARTIE would then be sent in along the wire, and directed to the anterior edge of the meningioma. If all went well, most of the two hours or more that would have been spent simply reaching the tumor by traditional methods would have been saved, to say nothing of the elimination of much of the damage to intervening structures.

Go, ARTIE!
Jessie cheered.
Go!

The insertion went perfectly, and was accompanied by murmurs of amazement from those in the crowd, when Gilbride announced he was in position and, ready to begin the dissection. Jessie had to admit grudgingly that the neurosurgical chief was handling the controls of their invention quite expertly.

The ultrasound liquefaction and removal of Hermann’s tumor began uneventfully. Gilbride, working with appropriate care, seemed firmly in control. In spite of herself, every few minutes, Jessie’s attention drifted away from the screens and over to where Alex was watching. From time to time, he was gone, no doubt going through the motions of his security job. But mostly he was there, up against his pillar, watching.

“Okay, Dr. Sanjay,” Gilbride said. “I think it is appropriate now to awaken our patient for some functional MRI mapping.”

Jessie studied the tumor image on the screen. About a third of the meningioma had been removed—the most accessible part. There was still a good deal that could have been melted away before Hermann’s cooperation was needed. It was almost as if Gilbride was stalling—doing whatever he could to delay an attack on the portion of the tumor that was most intimately adjacent to normal brain.

It took a while for the anesthesia to lessen. During that time, Gilbride continued to pick away at what remained of the bulkiest portion of the tumor. Jessie was watching the monitor nonstop now. She was certain no one else appreciated it yet, but several times, Gilbride had started ARTIE off in the wrong direction, then quickly reversed. He seemed to be having trouble with the spatial relationships between the views of the tumor and the movement of the robot. To Jessie, ARTIE was essentially a videogame race car, able to move in any direction, but with controls that were in a fixed position. So when ARTIE was moving in one direction, a right-hand move on the control panel meant a right turn. But in the opposite direction, a right turn meant going left on the controls, and in between, there were literally an infinite number of permutations. To a video-game junkie like Jessie, the moves were second nature. But she could see that as the field of surgery grew smaller and smaller, Gilbride was having more and more trouble maneuvering.

Twice he turned off the audio and called Skip Porter over for a whispered exchange. Both times, apparently assured by Skip that the robot was functioning properly, Gilbride returned to the surgery.

“Count Hermann,” he said now, “lift your right hand a bit if you can hear me.”

The translator, a nurse who had translated on occasion for some of Jessie’s patients, spoke from behind Gilbride, just to Eastman Tolliver’s left. Despite his adequate comprehension of spoken English, it had been the Count’s decision to have commands relayed to him in German. If Alex was right about the man’s facility with languages, Jessie was thinking, the request was part of the charade. Through the overhead camera, Hermann’s chest, where his hands rested beneath the drapes, was visible. Immediately after Carl’s order was translated, the Count responded with the requested movement.

The operation proceeded for another twenty minutes. Jessie wished the overhead camera was focused on ARTIE’s control panel rather than the essentially static operative field. That view, along with the MRI, would have told her a great deal. Again and again now, as the dissection became more difficult, she saw Gilbride miss once, even twice, before directing the robot along the proper course. The errors were minuscule hitches—like the feints of a prizefighter before striking in the other direction. But they were errors nonetheless. She was certain of it.

As ARTIE ate more and more into the tumor, closer to normal brain, Gilbride was clearly having more and more difficulty controlling its movement. At one point, where fibers of normal brain had to have been damaged by an errant thrust, Hans Pfeffer looked over, caught Jessie’s eye, and shook his head grimly.

Alex, perhaps reading her expression and intensified concentration, managed to connect with her long enough to mouth the words,
What’s happening?
Her response was a shrug.

Gilbride placed the LED goggles on his patient and requested a functional magnetic resonance sequence, the brain mapping alternating with more dissection. Twice, Hermann seemed unable to follow commands. Both times, ARTIE was slightly off course. This was no mechanical failure. The technique, at this level, was simply beyond Gilbride’s ability. At one point Jessie thought he might back the robot out—admit he could go no further and simply opt for a full, open craniotomy. But Gilbride persisted. She wondered if it was getting to the point where he was pitting Rolf Hermann’s brain against a four-million-dollar grant.

Another muted conversation with Skip. Another helpless gesture by the research technician.

ARTIE is functioning fine
, Jessie could almost hear him whispering.