Brains

  Overbridge was taken down to the rehab room to see Pierre, who was working on a Stair-Master, rhythmically climbing stairs.

  ◆◆◆

  Upstairs, Perez and Maxwell were discussing this latest development.

  “This actually makes a lot of sense,” Maxwell was saying. “No newly-put-together team and hospital could hope to compete with the facility where he has done hundreds, or actually thousands of cases. We are putting everything on the line, everything needs to be done to maximize our prospects.”

  Perez was thoughtful. “I am still concerned with witnesses. How many new loose ends would this generate?”

  “From what I understand, just an anesthesiologist, a couple of nurses, and a scrub tech. The recovery staff would have no clue other than that they had a patient with a head bandage who had had a brain operation.”

  “How do we know he is not planning something?” asked Perez, who had stayed alive in a very dangerous world by staying on his guard.

  “I think we should make sure there is no time for that. Tomorrow is Sunday, let's have him do it tomorrow.”

  Perez looked at Maxwell. “Is the mesh ready?”

  “Ready, all wrapped up and sterilized.”

  “Is Blaylock ready?”

  “Yes, he told me he has completed the analysis of everything he got from the boy, so he's as ready as he will ever be.”

  “Get him up here.” He rolled over and stared out the window. Tomorrow. Was he ready for tomorrow? He fingered the insulin pump at his waistband, thought about the massive doses of lactulose he was taking to stave off the liver failure, the aching pain in his side that was now a constant feature of his day.

  Blaylock came in. “What's up, Boss?” he asked.

  Perez wheeled around. “We are thinking of doing the implant here in New York. Tomorrow.” Blaylock's eyes widened.

  “That would be sweet! I'm ready to go, and doing it here would make it so much easier than moving everything to Mexico.”

  “Did the data from the boy help?”

  “Immensely. I will need twenty-four hours of consciousness. Maybe less, if the subject-to-subject variability turns out to be less than anticipated. That's it. Nature made the brain a very orderly place, once you understand the code.” His smile was grim. “Of course, those twenty-four hours will consist of what most people would consider torture.”

  “No matter,” replied Perez. “As long as we get the results we need. That I need.”

  “I can virtually guarantee it,” he replied.

  “Okay,” Perez instructed Maxwell, “Get him up here and tell him to set it up for tomorrow morning.” He turned to Santiago. “Just tell him it's a go, tell him to have Maxwell take care of anything he needs, and leave before you say anything to screw it up.” Perez left the room.

  ◆◆◆

  When Overbridge returned, the plan to proceed the next day almost threw him, but he remained outwardly calm. “Why tomorrow?” he asked. “Don't you need more time to prepare?”

  Maxwell was smooth. “This weekend is perfect. We have everything here, and we are sure you can handle it.” He placed a large satchel on the conference table. Maxwell reached in and extracted a plastic skull, with a circular cut around the top, just at the level where a surgeon would remove the bone in an actual procedure. Inside the skull was a plastic brain.

  “This,” said Santiago, “ is a perfect model of Uncle Luis' brain and skull, made from his MRI scan and 3-D printed. I will let Mr. Maxwell give you the details. I must attend to another matter.” He rolled smoothly from the room.

  Overbridge picked up the model brain. The detail was amazing, and the program used to print the model had colored the vessels brightly, red for arteries, blue for veins, pink for the brain tissue itself.

  Maxwell pulled a manila envelope from the case. “Here is a duplicate of the mesh you will be using. Notice the connector on the posterior side. That will help you orient.”

  Like the mesh he had seen earlier in the dog lab, it was slightly springy, and maintained its shape nicely while lying on the table, despite how fine the fibers were. Maxwell set the mesh in place on the model, and then sprayed it with a fine mist from a bottle. The mesh essentially disappeared completely, just as it had on Pierre's brain. He then grasped the connector, and peeled it back off the model. “See, smooth and easy. In addition to the actual implant, I am sending you with two more practice meshes, so you can get familiar with the placement.” He replaced the skull and brain in the bag.

  Maxwell picked up the satchel, and carried it as he escorted Overbridge to the elevator. He handed it to him, along with a cell phone. “Just press one to call me with whatever you need to get things set up. It is pre-programmed with me on speed dial. Our resources are nearly unlimited. Don't be shy about making sure everything is correct.” The elevator doors closed.

  ◆◆◆

  He was silent on the drive to his apartment. That was nothing new, he was always silent. He was trying to make a list in his mind. He was confident that, if Luis survived surgery, Perez's people would certainly not try anything during the recovery period, which he had already discussed would be fairly long. He came to the conclusion that, for now, his best play was to do all in his power to achieve a successful implantation. Moreover, he wanted to do the implant. He was convinced that nothing could be more important. He was, frankly, excited.

  In the satchel containing the model of Luis’s brain and the several mesh implants, there was also a powerful laptop that, he had been told, had animations of the mesh and its attachments. He would need to study it thoroughly in order to make the surgery appear smooth, routine. There would be no hiding the mesh from the surgical tech and circulating nurse, so he needed to make sure that the on-call team did not include anyone who regularly worked in Neurosurgery. That would unavoidably mean a tech who knew nothing about the procedure. He would be alone, unable to take any of the usual short cuts allowed by having his team around him. He would need to be able to convince the OR staff that the mesh was a new product to deal with some possible complication or other. That should be okay – there were always new things, and only an experienced neuro-tech would be likely to doubt the explanation.

  It had been a long time since he last took weekend call, and he was not at all sure of the current procedure for arranging an operating room on the weekend. If he made inquiries too early, they would become suspicious if he did not want to start immediately. If too late, he would potentially have to wait too long to get started. He decided he would need to call in about two a.m. and tell them that he had a Mr. Luis Martinez who had an aneurysm that was showing evidence of leaking, and that he was on his way from New Jersey, and they needed to have the OR ready for him at six. That would be about right. They would whisk him up to the OR, and then. . . .

  He stopped. There was a variable he could not control. The anesthesiologist. Everyone in the anesthesia group spent time in the neurosurgery rooms. They would be able to tell immediately that this was no ordinary aneurysm. They were smart, and they were often so bored that they would watch entire procedures. They knew their brain anatomy, and they were not afraid of him. In fact, they seemed to relish giving him a hard time. He would have to disable the video system completely, and would still be at risk of discovery.

  He had a sudden flash of inspiration. He pulled out the cell phone Maxwell had given him and called.

  “Hello, Mr. Maxwell?”

  “Yes.”

  “I have some unusual requests.”

  “Go on.”

  “Are you able to get into the hospital’s computer system? I need to access the surgical tech and nurse on-call list, which would have the names and contact information for the personnel. I am sure it is kept on computer, as they have practically no paper at all in the ORs.”

  “That should not be difficult. Anything else?”

  “Yes, are you able to disable specific phone numbers, so that, if called, they will not go through?”

  �
��Easily.”

  “Finally, would your people be able to insert an article into the on-line edition of a medical journal. Actually, just the abstract?”

  “Interesting, but yes, I’m certain it could be arranged.”

  “Very good. If you can get the surgical nurse and technologist call schedule to me as soon as possible, I will be able to tell you which numbers I need blocked. I should have the abstract written within the next hour. How do I get it to you?”

  “Email it to me.”

  “I only have work email. I don’t have internet service at my apartment, either.”

  “The phone you are holding is a wi-fi hot spot, and the laptop I sent with you is already linked to it. I took the liberty of setting up an email account for you to use. It will come up automatically. The email to use for me is also programmed as 'Maxwell.' Send me an email as soon as you have the computer set up. My people will likely have the list for you by then.”

  “Okay.” He hung up, feeling slightly silly. They were just pulling up to his apartment.

  ◆◆◆

  Once inside, he set up the computer, plugged the phone charger into the wall socket, and opened up the browser. Indeed, he had service. He opened the mail server, then sent an email to Maxwell. In return, he received an email with the call schedule attached. Our Lady of Salubrious Penitence had four complete teams on call, with another four on back up. He scanned the names. Of the eight techs, three were problems, as well as two of the nurses. He sent their names to Maxwell, with the instruction to disable their phones before two a.m. He then thought about it some more, and sent him the names of every other neuro nurse and tech, whether on call or not, just in case some well-meaning do-gooder tried to help him by calling in someone special.

  He then opened Word and began to write his abstract. “Reduction in Re-do Post Craniotomy Edema Using Microfibrillar Cortical Mesh and Di-Electric Pulsed Stimulation.” That was a mouthful, he thought. The abstract described how, in patients that had had previous brain surgery, there was less fluid pressure build-up using a new device that sealed the surface of the brain and stimulated it via an externally connected device. I hope that’s adequate.

  He mailed the abstract to Maxwell, with instructions to insert it into Neurosurgical Review from the prior July. Overbridge received all his journals in paper form, but he accessed them at work occasionally on line, and knew that particular journal made abstracts available to everyone, whereas the articles themselves could only be purchased by members of the neurosurgery association. If the anesthesiologist became curious or suspicious, Overbridge would simply reference the article, and explain that he had received a new prototype that was perfect for this case.

  He then mocked up an emergency encounter form from a small hospital in southern New Jersey, which gave an imaginary history for Luis Martinez, and a report of the CT angio showing that his previously clipped aneurysm was leaking. In reality, he would normally require much more imaging than that to go back to the OR with an aneurysm, but he only had to satisfy the OR desk, not a neurosurgeon. He emailed it to Maxwell, and told him to have Luis arrive at Our Lady via ambulance as close to six a.m. as possible. He, Overbridge, would be waiting in the ambulance bay.

  All of this took almost three hours, and his own brain was pounding as he finished. He set an alarm for two a.m., and went to bed.

  At two, he called the operating room, explained that he had an emergency redo coming in from New Jersey, and told them to have the neurosurgery OR open and ready by six. There was a little grumbling, which he ignored. He also called admitting and told them the same thing. They were able to pull up Mr. Martinez’ fake record from New Jersey easily enough, and gave him no trouble. No trouble at all. He went back to sleep until five. It would be a long day.

  Chapter 35

  Sunday, November 6

  New York

  The ambulance arrived at Our Lady at 6:03. Dr. Overbridge was waiting, and walked with the patient in through the Emergency Room to the after-hours admission desk. They had all the information from the imaginary prior admission in New Jersey, and Luis was up to pre-op in less than a half hour. The anesthesiologist walked in. Michelle Fujami. Perfect. She never showed more than a cursory interest in the procedures. I should have slept instead of spending so much time on that fake abstract, Overbridge thought. Better use of resources.

  “Hi, Dr. Overbridge,” Fujami extended her hand. “Any idea how long this will be?”

  “I really don't know. There are some special considerations. I would guess about ten hours.”

  Fujami stopped and turned. “Ten hours? I've never heard of you going longer than four.”

  “As I said, there are special considerations. His prior surgery was performed by, shall we say, one of my less proficient colleagues. I will be using a new cortical implant, and it will require some extra work. This patient is at particularly high risk for hydrocephalus.” He then introduced Maxwell as the equipment company rep, who had been so kind as to bring in the new implant, and who would be observing the procedure.

  “Okay, whatever.” Everyone knew that arguing with Overbridge would be an exercise in futility. She checked the chart, and went over to talk to the patient. When she was told the patient was both deaf and blind, she just listened to his lungs and heart, and headed off to the operating room to get things ready.

  When they got to the operating room, Overbridge walked over to the sterile back table and opened the sterile pack containing the mesh. He pointed to it and said to the tech, a middle-aged portly man he had never met, “Do not touch this implant. I don’t want any water or saline anywhere near it. Just leave it there. I will get it myself when it is time. Got that?” The tech nodded.

  Once the patient was anesthetized, Dr. Overbridge quickly affixed the rigid circular titanium halo to the skull just over the ears and eyebrows with six pointed screw grips, which then allowed him to fix the head firmly in place at the correct angle, the bed configured so that the head was upright, giving him easy access all around the top of the skull. The actual surgery began with an incision from just behind the left ear, over the top of the head to just behind the right ear. Dr. Overbridge took it smoothly and expertly down all the way to the bone. He clamped the scalp edge with a series of clamps that resembled small bull-dog clips with teeth, preventing any bleeding. The skin of the scalp and forehead was then separated from the skull, and turned inside out over the face, out of the way. The back side was also raised off the skull and flipped down. At this point the entire top half of the skull was bare, glistening white in the strong OR lights. He used a bone saw to cut all the way around, just above where the halo was attached, his depth perfect and precise, with the whole surgery to that point having cost less than a teaspoon of blood loss. The entire top of the skull was lifted off in one piece, peeling with a sucking sound from the underlying dura, which itself was a dull white, like a thin leather. He incised the dura by making a small cut with a scalpel, then used scissors to make an H-shaped opening, which he peeled back to expose the cerebral cortex.

  He stopped for a moment to admire the brain. He had never exposed it completely like this in a living patient, and, as always, touching the brain was almost a religious experience. The tissue pulsed with each heartbeat. Today I re-attach this brain to the world, he thought reverently.

  Things were going well. He commenced his act, working under the microscope, carefully exposing the area of the supposed aneurysm, and expertly applying a clip adjacent to the perfectly normal artery. A successful placebo operation, he thought to himself. All of that would have looked entirely normal to anyone who could not actually see through the microscope, which no one could. He had surreptitiously dripped a drop of superglue onto the lens of the camera, which made it look like the focus was broken. With the limited tech support on the weekend, there was no one to fix it.

  So far, so good.

  ◆◆◆

  It took them the better part of an hour to fully bring SAC Crawley up to
date on everything. He was not a happy man.

  “So, what you are telling me is that you two killed a man in Manhattan Friday, and fled the scene. And you,” he said, pointing at Mitzi, “are not even an Agent. You're essentially a lab tech. You can't even legally carry a weapon.” Crawley threw up his hands.

  “Actually, that's not correct, sir. I am a Special Agent, did the whole Quantico thing after medical school, then the Bureau was enthusiastic when I went back to train as a pathologist. Check with H.R.” She pulled out her credentials. “I am just not currently functioning as a field agent.”

  Crawley stared at her. “Okay, so I just suspend you instead of arrest you? Where's the gun.” She handed it over. “Not a service piece,” he noted.

  “No,” she acknowledged. “Burner gun to go with my burner phone.” She attempted a smile.

  Kevin Crawley drummed his fingers on the desk. “What a mess. On the one hand, they attacked you, so it would normally be a righteous kill, but you fled. What were you thinking?”

  “That NYPD is not the right entity to follow this through,” Cameron replied. “This is a terrorist organization, falls under ATU authority.”

  “So, what do you think I should do?”

  “We were hoping you could help us get some Agents to push through investigating ServCorp to try and establish a firm link with Perez.”

  “Tell you what. Both of you give me your credentials and guns. I assume you have an actual service piece in that purse?” Mitzi nodded and they both handed over the items as requested. “Be back here tomorrow morning at eight. I need to give this some thought. Do you have somewhere safe to stay?”

  “Yes, sir,” Cameron replied.

  “Go there. See you tomorrow. Try not to kill anyone.” He waved them out.

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