Patient (24 page)

“One more minute and you’re done here,” Arlette said. “And I mean it. I gave you your chance.”

“Go for it, Jess,” Emily said.

Jessie gripped the catheter and with a twisting motion forced it into the ventricle. Instantly, spinal fluid under high pressure shot through the catheter, actually hitting Emily on the sleeve.

“Yes!” she exclaimed. “Oh, Yes!”

Quickly, Emily fixed the catheter to a drainage system.

“Time’s up!” Arlette announced. “Let’s go, Doctor.”

“I can’t leave her yet,” Jessie implored.

Arlette readied her weapon and strode to the bedside, clearly ready to finish Sara off.

“I’ll stay with her,” Emily said quickly.

Arlette glared at her.

“You’ll do nothing of the sort. I want you both out of here and on your way to the operating room.”

Her voice was strident now. Jessie was certain that at any moment she would simply raise her weapon to Sara’s head and blow it apart. But the drainage catheter hadn’t even been sutured down yet. What if it got pulled out, or plugged? What about antibiotic coverage for what was hardly a sterile procedure? What about steroids or other treatment for brain swelling?

“Okay, okay,” she pleaded. “Don’t shoot her. Please. We’re going. We’re going.”

“I’ll take care of her.”

Carl Gilbride spoke from the doorway, then stepped into the room, with Armand right behind him. His cheek was bandaged, and he looked disheveled in his bloodstained designer shirt and lab coat. But his eyes were clear, and the purpose in them unmistakable. For several seconds there was only silence.

“Thank you, Carl,” Jessie said softly, pushing herself off the bed to make room for him. “Thank you.”

“Now!” Arlette barked. “Let’s go.” She turned to Armand. “Let Dr. Gilbride do whatever he needs to here.”

“Jessie,” Gilbride said as she reached the door, “what antibiotics do you want her on?”

Jessie turned back to him and, for the first time in longer than she could remember, liked what she saw of the man.

“You decide,” she said. “I trust your judgment.”

Chapter 34

THE TRANSPORT TEAM CONSISTED OF JESSIE AND Emily, Grace and Derrick. Armand and Arlette were to remain on Surgical Seven. Another terrorist the one who had held Emily captive in a room somewhere in the subbasement of the hospital-was not accounted for. Jessie strongly suspected he was either keeping an eye on Richard Marcus, or was outside, somewhere in the city, positioning himself to detonate one or more of the vials of soman should anything go wrong.

Just having Emily there with her made the entire ordeal more bearable, although since her arrival back on Surgical Seven, there hadn’t been one moment when the two of them could talk in private. Once they were in the OR, though, there would be a chance, thanks to the relative privacy of the space between the MRI tori.

Although ARTIE was scheduled to perform the entire operation, Malloche’s head had been shaved as a precaution should Jessie have to go to a full craniotomy. He lay calmly on the stretcher, holding hands with Arlette. His headache had responded reasonably well to the narcotic injections, but he had needed to be kept almost constantly medicated throughout the night.

“You’ve done a good job holding everything together,” he said to his wife in French. “I’m lucky to have you.”

“No,” she replied, “we’re all lucky to have you.”

Jessie refrained from letting them know her French was passable.

Sweet monster love
, she thought.
Spare me!

The elevator doors opened and Claude Malloche was wheeled inside.

“Grace, you have the gun?” he asked.

“Right here,” she replied, tapping the shoulder holster beneath her lab coat.

“Wait a minute,” Jessie said. “If she’s planning on coming into the operating room, everything metal must be left outside. The electromagnet would pull that gun right through someone’s body.”

“Correction,” Malloche said. “Everything
magnetic
must be left outside. Grace’s little thirty-eight is a custom order cast especially for our visit here. Titanium, I think, and goodness knows what else, but nothing magnetic. And trust me, Grace knows how to use that pistol well. I forget, Grace, how many people have you sanctioned since you came to work with us?”

The slender American shrugged matter-of-factly.

“I don’t know,” she said. “Nineteen? Twenty? I don’t keep count exactly. I just do what I’m told.”

“Please let that serve as a warning to you, Dr. Copeland. Do my operation well—no, do it perfectly—and get me back up here to recover. If there is anything that seems the least bit out of place or subversive of our goals, Grace, here, has instructions to shoot Mrs. DelGreco. We will then send Dr. Gilbride down to help you finish my case. Is that clear?”

“Clear.”

“Good.”

Jessie flashed a look of hatred down at Malloche, but his eyes had closed and his mellow half-smile suggested that he had allowed himself to yield to the euphoria of his pre-op medications.

“Dr. Copeland,” Arlette said, “Derrick will be stationed outside the operating room. He is to be introduced to the others as being from hospital security, sent by Richard Marcus and his infection control team to ensure that no unauthorized personnel enter the operating room. Claude and I have reviewed this list you gave us of participants in his surgery. It will be Derrick’s responsibility to see that nobody who is not on the list is allowed in the operating room.”

“I understand.”

“There is one name in the group that we are concerned about. Dr. Mark Naehring. Exactly who is he, and what will he be doing?”

It was not the actual question that caught Jessie off guard, so much as the timing. She wasn’t at all certain Naehring would even show up in the OR, but she had decided it would be foolish to leave him off the list of participants that Malloche had demanded from her. As they were wheeling Malloche to the elevators, Jessie had allowed herself to believe that Naehring’s name had simply slipped past them. She should have known better. Now, she wondered how much truth should be laced into her response. If Malloche or Arlette had looked up Naehring in the annotated directory of EMMC physicians, they would know something of the man. Any contradiction now between what Jessie told them and what they had learned would be a red flag, and would almost certainly put an end to her already shaky plan.

“Dr. Naehring is a psychopharmacologist,” she said carefully. “I intend to do a great deal of surgery with your husband awake and responsive. Dr. Naehring is more experienced and expert at administering medications that allow patients to be maintained at that level than anyone in anesthesia, including Dr. Booker.”

Several frightening seconds passed during which Arlette assessed the information. Finally, she handed the list over to Derrick.

The elevator doors closed, and the five of them—Malloche, Grace, Jessie, Emily, and Derrick—began the descent to the subbasement of the Surgical Tower. Ordinarily, before a difficult case, Jessie would have spent an hour, often more, in her office, poring over MRIs and neuroanatomy textbooks, setting up her plan for the surgery, and reviewing the anatomy she would encounter. Never before this moment had the elevator ride down to the OR doubled as her pre-op preparation.

Random snatches of thought passed through her mind like a meteor shower, making it difficult to concentrate on ARTIE and on Claude Malloche’s meningioma. This was hardly the state of mind she wanted to be in for a major case—much less one that could have such grave consequences. Throughout the operation, her ability to stay focused would determine the outcome as much as her surgical skill.

The elevator doors opened, depositing them just down the hall from the MRI-OR.

“I will be with you every inch of the way,” Grace said to Jessie as they pushed the stretcher toward the OR.

Jessie could see Michelle Booker waiting for them in the prep area, but there was no sign of Mark Naehring.

Damn
.

It might well be academic now, Jessie realized, but Emily had no idea that Naehring had even been called in. She also reminded herself that at the moment, Michelle Booker might be sensing that this case was unusual, but she wouldn’t have a clue as to why. It was going to be essential to find ways to communicate the situation to each woman without endangering anyone. Fortunately, they were among the sharpest people she knew.

What if the psychopharmacologist didn’t show up? she asked herself now. Was there any way she could handle the drugs? He used some sort of mixture of three hypnotics—or was it four? Clearly, the answer to her question was a resounding no. If she tried using drugs to interrogate Claude Malloche and somehow screwed up, there was no doubt in her mind that a great many people would die.

Jessie introduced Grace to Michelle Booker as a biomechanics student from Chicago who had written her some time ago expressing an interest in ARTIE. Then, as instructed, she introduced Derrick to the console tech Holly as a hospital security officer, who was not going to allow anyone into the operating room other than those on the list she had provided for him. Neither of the lies would survive much conversation, but Holly and Michelle were usually all business anyhow, and the seriousness of the procedure was certain to keep them zeroed in on the patient.

The first real opportunity Jessie had to pass any information to Emily was in the scrub room. With her identity as a biomechanics student established, Grace had to remain several paces away from them. Jessie began her scrub by turning up the water full force so that it splashed noisily in the stainless steel sink. Emily quickly followed suit.

“I wish I knew how Sara was doing,” Jessie said, looking straight ahead as she spoke.

“Me, too. Jess, I know you’re feeling guilty about not insisting on going in to see her last night, but you really had no choice. And you did a helluva job at getting that catheter in.”

“Thanks. I don’t mind telling you now that I was scared stiff. Em, listen. I tried to get word to Alex last night to have Mark Naehring come down here.”

“The drug doc who called you the other day?”

“Exactly.”

“What for?”

“Come on, you two,” Grace called in over her shoulder. “You said four minutes.”

“To use his stuff on Malloche so I can question him about the soman,” Jessie said. “Naehring may not show up at all, but if he does, just follow my lead and do what you can to help me replace you with him.”

“Does Michelle know what’s going on?”

“Not yet. You’ll have to help me out there, too.”

“Keep Grace with you outside the OR for a few seconds, and I’ll see if I can at least tell Michelle that there’s some weird stuff going on around this case and she should be on her toes.”

“Just be careful. The microphones are on. Everything you say will be broadcast out here.”

Emily shook the excess water from her hands. “Okay, it’s show time,” she said. “Give me a minute or so in there to get gowned, then you can make a grand entrance like Gilbride always does.”

“I don’t know if I can pull it off without the scepter, crown, and cape.”

Thirty seconds of stalling was the best Jessie could do before Grace ordered her into the OR. Skip Porter, masked, gloved, and gowned, was just finishing preparations on ARTIE. Outside the window, she could see the console tech and radiologist Hans Pfeffer, preparing their equipment and checking communication with the computer lab upstairs. Behind them, standing almost at attention, was Derrick. He was posing as a security guard but he was inside the area where only scrubs and lab coats were allowed. His loose white coat, buttoned once in the front, completely hid the deadly machine gun that was slung over his shoulder. It was just past six-thirty. By eleven—noon at the latest—the resection of Claude Malloche’s tumor would be over.

What then?
Jessie asked herself.
What then?

She accepted a towel from the scrub nurse and thanked him for coming in.

“No problem,” he said. “Why the big deal about this case?”

“Eastman Tolliver is the administrator of a fund that is about to give the hospital several million dollars in research money.”

“That’s why Richard Marcus is so anxious to get his operation done?”

“Exactly.”

“Well, I’m sorry I made a big deal about coming in, but I’ve got two little kids, and this virus thing really has me spooked.”

“I understand. Believe me, I don’t want to die any more than you do. Trust me that it’s safe. There have been no new deaths on Surgical Seven, and Mr. Tolliver’s been kept well away from the floor since the outbreak.”

Jessie slid her arms into the sterile gown he opened for her and then thrust her hands down into her gloves.

Spooked by the virus thing
, she was thinking.
Nice going, Claude. You don’t miss a trick, do you.

“Emily, I’m all set,” Michelle Booker called out. “He’s under and intubated. I’m going to slide him through.”

Jessie stood back and watched as the padded platform bearing Malloche was eased along its track through the opening in the magnet to her right.

“Ready ... and ... stop,” Emily said when his head was positioned in the two-foot separation between the massive tori—the tightly contained universe where, for the next five hours or so, she and Jessie would work.

Emily began by prepping the area around Malloche’s nose, and another at the hairline. The second site was for backup in case ARTIE could not be inserted through the right nostril as planned. Jessie remained outside the magnet. It was time to get Michelle Booker into the act.

“Michelle,” she said, “there’s a possibility that Dr. Naehring may be coming down to assist with part of this case.”

The anesthesiologist looked up quickly.

Stay cool
, Jessie’s eyes begged.
Stay cool
.

What on earth are you talking about, woman?
From above the top of her mask, Booker’s wise, dark eyes asked the question.

“Mark Naehring,” she said matter-of-factly. “I admire his work.”

Tell me more.

“When we get to doing the functional MRI, he’ll take over for you. But he’ll be working across from me at the table, where Emily is now.”

“That’s an interesting approach. I’ve never done a case like this with him before.”

Are you crazy?

“I hope he gets here. If, by any chance, he doesn’t make it down, would you be able to handle the meds the way he did at grand rounds?”

Michelle made the faintest gesture toward Grace.
Does she have something to do with this craziness?

Jessie nodded. Beneath her mask, she was smiling. Michelle Booker had no idea just what the ship was or where it was headed, but she was on board.

“I suppose I could try some of my own combinations,” Michelle said, “but Naehring’s the pro.”

“If we have to do it that way, I’ll send Emily over to you for a quick in-service on monitoring the anesthesia equipment, and you’ll get gloved and gowned and work with me.”

I sure hope you know what you’re doing
, Michelle’s eyes were saying now. “Hey, no problem,” she said. “I like to teach.”

Jessie moved into her spot across from Emily, and together they draped Malloche’s head and fixed his skull to the titanium immobilization frame. Grace was now screened from them by Jessie’s back, although she was just a few feet away. She would have been able to observe more and hear more by standing on a riser, but Jessie had thought to nudge the two risers they had out of sight under an equipment table. Now she switched off her microphone and motioned to Emily to do the same.

“We can’t keep these off for too long or Derrick will get suspicious,” she whispered. “You keep yours turned off. We’ll just use mine.” She switched her microphone on again. “Okay, everyone, on your toes because we’re ready to roll. Jared?”

“Ready,” the scrub nurse said.

“Sylvia?”

“All set,” replied the circulator.

“Skip?”

“All systems are go.”

“Hans?”

“We are ready.”

“Holly?”

“No problems.”