by Carl Goodman
Chatham looked a little pained. ‘We do, but we try to avoid it. It seems such a crude tool in this day and age.’
Eva frowned. ‘I thought laser was state of the art?’
He smiled a slightly deprecating smile. ‘Far from it. To be sure it’s gone through a number of improvements since photo-refractive keratectomy was introduced in the 1990s. Treatments include 3D scans of the eye for more detailed contour maps and the accuracy of computer-controlled lasers is very impressive.’
She could hear the reticence in his voice. ‘It sounds like there’s a “but” coming?’
Chatham grinned. ‘But. The problem with laser is it’s a temporary solution. We make a 270-degree cut into the corneal epithelium, the surface of the eye, using a bladed tool called a trephine. We then hinge the flap up and burn off the surface of the cornea to reshape it. I say “we”; in fact it’s a computer that performs that part of the surgery, according to scans that have been made. It even calculates the amount of reshaping required. The problem is with presbyopia, the hardening of the lens that occurs naturally when you enter your mid- to late forties. It’s why you will eventually need reading glasses. Presbyopia is a defect in the lens of the eye itself, so no amount of surgery on the cornea can help it. So sure, laser surgery will provide good results in younger years, but as you get a bit older your problems will be the same.’
Eva shook her head. ‘What has this got to do with our victims?’
‘Well,’ Chatham said, ‘all I can say is that they opted for an alternative approach, one we here at the Chatham Centre champion and which is becoming increasingly popular. It’s called Refractive Lens Exchange.’
Eva had to double-check. ‘All three of the victims had this?’
‘Yes, according to our records. We have a proprietary solution that we call Bright Eyes, at least our marketing people do. I could show you a video?’
Eva winced. ‘Do you have to?’
Chatham smiled and turned a computer screen so that they both could see it. ‘No. A visual aid might be useful, though.’ After a few moments scrabbling around with a mouse he opened up a diagram of a human eye. ‘A quick summary of the important bits.’ He pointed at the diagram with his finger. ‘Here’s your eye. At the front is the cornea, covered by the corneal epithelium, which is the outer surface of the eye. Behind the cornea is the iris. That’s the coloured section of the eye, which in your case Detective Inspector is quite a fetching shade of green.’ Eva did not know how to react, but Chatham continued before she could. ‘The black section in the middle of the iris is the pupil, which is of course basically a hole in the sphincter muscle of the iris that expands and contracts depending on light levels. Behind all that is the lens, suspended in the posterior capsule, and the muscles that squeeze it in order to control focus. Behind the lens is the vitreous humour, the liquid that fills and shapes the eye. At the back of the eye is the retina, covered in rods and cones, which are the cells that respond to different wavelengths and intensities of light. The wavelength of a light wave determines its colour,’ Chatham added.
‘I know that much,’ Eva told him.
He nodded. ‘The lens focuses light onto the retina and the cells record the image. The image is transmitted to the brain via the optic nerve, which is that connection right at the back of the eye. All clear so far?’
‘Crystal,’ Eva muttered.
‘Okay. So the problem is with the lens, which can quite commonly be slightly misshapen, resulting in short-sightedness, long-sightedness, astigmatism and all the usual optical defects. As I said, laser surgery seeks to compensate for those defects by reshaping the cornea. There’s a better solution.’
‘Which is?’
‘Replace the lens. That’s about the commonest surgical procedure there is, and it’s exactly what happens in cataract surgery. The big question though,’ Chatham said as he turned the screen away from her, ‘is what do you replace the lens with?’
She waited. She knew he was giving her the edited highlights, but indulging Robin Chatham seemed to be the fastest way of getting answers concerning Irina Stepanov, Jodie Swain and Paul Markham.
‘In standard cataract surgery such as performed on the NHS,’ Chatham continued, ‘you are given a mono-focal refractive lens. Let me break that down. “Cataract” is the term for the clouding of the eye that becomes prevalent in your sixties and seventies, usually caused by over-exposure to bright sunlight. Mono-focal means a lens that focuses at one distance only, usually at far distance, so a patient with standard mono-focal lenses to replace cataracts will generally have good distance vision but will usually still need reading glasses. A refractive lens is like the biconvex lens in a camera,’ Chatham cupped his hands together as though encompassing the shape, ‘which is basically the same as the natural lens in your eye. Still with me?’
It wasn’t actually that complicated. ‘So far,’ Eva said.
‘Good. But what if you wanted clear vision at all distances? How would that work? You couldn’t use a refractive lens, because without complicated focusing equipment it would only work at a single distance. You’d need an alternative type of lens. That’s where the idea of using a diffractive lens comes in.’
‘Diffraction. Like they use in holograms for credit cards?’
‘Exactly,’ Chatham told her. ‘A diffractive lens, sometimes called a Fresnel lens, is also the kind of thing they use in lighthouse beacons to increase the range covered by the lamp. It looks like a series of concentric circles. Each circle is a torus, a doughnut shape basically, that acts like an independent lens in its own right.’ He glanced at his watch.
‘Am I keeping you?’ Eva asked.
‘I’m more than delighted to explain what it is we do here in as much depth as you require, Detective Inspector,’ Chatham said. ‘The only problem is I have a patient to attend to. Perhaps that isn’t a problem though,’ he added.
‘I don’t understand?’
‘The best way to explain what it is we do here,’ Chatham told her, ‘is to show you. Let’s go,’ he added as he stood. ‘We need to prep for surgery.’
* * *
He led her to a changing room. Chatham knocked on the door before he entered but the room was empty.
‘This is the female nurses’ dressing area. Try these.’ He handed her a set of surgical scrubs. ‘When you’re ready go through that door and we’ll wash up. Don’t worry, it’s quite a lightweight procedure.’
Eva left her outdoor clothes on one of the hangers provided. The nurses must already be in surgery, she assumed. She felt slightly nauseous. Did she really want to stand over Robin Chatham’s shoulder while he did whatever it was he was going to do with somebody’s eye? Chatham seemed enthusiastic and engaging, though. And she had a duty to find out as much as she could.
He met her in the room next door, a room without windows, lit with bright LED strips and containing only a large stainless-steel sink and a mirror. She followed his instructions and washed her hands, put a surgical mask over her mouth and a plastic cap over her hair. Chatham didn’t touch the double doors with his hands as he shouldered his way into the operating theatre. ‘Good morning everyone,’ he announced as he barged in. ‘This is Ms Harris, she will be observing our procedure this morning.’
She saw three other people in a large room lit only in the centre by spotlights hidden in the ceiling. The edges of the room were in darkness. On what looked like a reclining chair in the middle of the room she saw a woman, in her mid-forties, Eva guessed, dressed in a surgical gown.
Another thought struck her then, one that wormed its way into her brain and ran like ice down her spine, the sudden realisation that she was in an operating theatre with four people who had precisely the skill-set needed to commit the murders. Eva looked around the room. She could not be certain, but at least two of them had physiques that might possibly match those of the individual she had fought with in St Jude’s Hill, although the scrubs made it hard to be sure. The anaesthetist was seated, so
she couldn’t be certain. The nurse who monitored the equipment in the room was on the opposite side of a screen. And yet, even if the killer were here, surely they would not do anything in the middle of a routine operation? She didn’t understand their reasons, Eva reminded herself. She didn’t know what they were capable of.
‘The reality is that this is quite a minor procedure,’ Chatham explained as he checked his instruments. ‘We are going to replace Ms Donaldson’s imperfect lens with a new, diffractive lens, which we have developed in conjunction with a rather exceptional lens design and manufacture company in Slovakia. You may know the former Eastern bloc had a reputation for excellence in optical design,’ – Eva had not known that - ‘which rather cuts to the heart of it.’
The woman had an intravenous catheter leading into the vein in her hand. The anaesthetist attached a syringe to the end of it and pushed a small amount of fluid into the tube. ‘A sedative,’ Chatham explained. ‘The procedure is conducted under mild sedation and local anaesthetic.’
She had been staring at the individual administering the drug, but her attention snapped away. Eva glanced back at Chatham. ‘Propofol?’
‘Exactly,’ Chatham agreed. ‘The anaesthetic is administered in two stages. We numb the eye with drops first of all, and then give a small injection into the side of the eye. Apart from pain relief the important point is of course that we don’t want the eye moving during surgery.’
The anaesthetist and the surgeons bustled around the woman for a few minutes. She kept watching them, trying to see if any of them could have been the person who had jammed a taser into Moresby’s neck, but the loose-fitting surgical scrubs made it hard for her to decide. Behind them Eva saw a TV screen come to life. A camera had been moved into position. On the screen she saw an enormous close-up of the woman’s eye, eyelid held open by a metal retractor, pupil chemically dilated.
‘What’s so special about the procedure you perform here?’
‘It’s mostly down to the type of lens we implant.’ Chatham shrugged. ‘I might also add that it’s down to the excellence of the surgery, but that would be immodest.’ He glanced at the people around him and received nods from them. ‘Let’s begin then.’ Eva watched the screen transfixed, repulsed but unable to look away.
Chatham made a small incision in the side of the eye. She forced herself to keep watching as the narrow blade pushed against the surface. There was a momentary pop as the transparent flesh lost tension, and then the metal tip was inside the woman’s eye. ‘First step is to remove the natural lens. We use ultrasound to break up the old lens in a process called phacoemulsification.’ He did it as she watched. He used another metal probe with a tip only a few millimetres across. She saw the lens start to disintegrate.
‘Irrigation on.’
Eva jumped. The voice had come from beside her, not from one of the other people in the room but from a machine. On the screen the lens started to seep out of the incision in the eye. Chatham kept probing until all of it was gone. ‘Irrigation off,’ the machine informed her.
‘At this point most surgeons would insert a rolled-up lens made from the kind of material used in soft contact lenses, which is a good candidate for mono-focal intraocular lenses. The trouble is that manufacturers have tried to use it for multi-focal and tri-focal Fresnel lenses, but the optical quality is quite disappointing. We use something different.’
Chatham showed to the camera a container that held an oddly shaped piece of plastic. ‘It’s the material hard contact lenses are made from, and optically far more satisfactory.’
It didn’t look like any sort of lens Eva had ever seen. ‘What is that?’
‘This,’ Chatham told her, ‘is Bright Eyes, the world’s first quad-focus intraocular lens. Capable of producing clear, sharp and artefact-free images at near, far and two intermediate focal distances. This is probably the most significant step forward in visual acuity since God allegedly created the human eye. It’s a work of science and art. We truly have outdone nature.’
He believed it. He really did. She could hear it in his voice. Eva stared at the object that Chatham presented reverentially to the camera. She could see the fine, flat disc of the Fresnel lens. She was caught between watching the other people in the room, attempting to see if their behaviour gave any indications of malicious intent, and trying to understand what Chatham was telling her. ‘What are the pieces on the side?’ She meant two hook-like shapes that gave the lens an almost ‘S’ shape.
‘They’re called haptics. We use them to position and orientate the lens. Next,’ he told her as he removed the lens from its container, ‘we widen the incision.’ He used another thin, bladed tool to slice almost halfway around the side of the eye. He lifted the parted, transparent flesh to test the cut. ‘Now for the pièce de résistance.’ She expected some flourish, but instead Chatham stepped away from the patient completely. When she saw what he was doing Eva’s jaw dropped.
‘You’re using a robot?’
‘It’s an automated process,’ Chatham agreed. ‘Like the computer that controls the beam in laser eye surgery, we’re now using a computer to control the insertion process.’ A sudden flash of light. The glint of a stainless-steel implement stabbing into the eye and it was done. ‘I pride myself on being a particularly fine surgeon,’ Chatham told her, ‘but this machine is two orders of magnitude more precise than any implantation I could make. It’s performed almost a thousand of these operations now, without so much as a hair’s-breadth of an error. A perfect lens and a perfect surgeon.’ He placed what looked like a clear contact lens over the patient’s eye to protect it while it healed and then signalled for a nurse to add antibiotic drops. ‘Now what we’re looking for is a perfect price.’
‘I don’t understand,’ Eva admitted. The other people in the room were clearing up now. The anaesthetist and other assistant seemed busy and no longer interested in the woman in the chair. Only the nurse paid her any attention, and physically she could not have been the person Eva had seen at St Jude’s Hill.
‘This procedure is currently expensive. We want to get the cost down, and we believe we can. Think of it,’ Chatham said as they watched the woman being wheeled out of the operating theatre, ‘if we can achieve the right price point then this surgery will become the de facto solution for almost every kind of visual problem there is. Forget glasses and contact lenses. With one single treatment Bright Eyes will give you perfect vision for the rest of your life.’
When Eva had dressed again Chatham took her to meet the rest of the team. They sat in a presentation suite surrounded by marketing material. Large high-definition screens churned through impressive statistics and flying logos. The name ‘Bright Eyes’ in a tasteful, sans-serif font appeared everywhere.
There were three of them. Two men and a woman. ‘Detective Inspector,’ Chatham said, ‘may I introduce Nicola Milne, Neal Garrick and Jeremy Odie. Nicola is our most excellent senior optometrist. Neal sometimes also claims to be an ophthalmic surgeon,’ Garrick snorted amused resentment. Chatham grinned indulgently, ‘and Jeremy is our quite brilliant head of business affairs who has created the relationship with our Slovakian partners.’
They seemed like the kind of team you would be happy to show off photos of in sales brochures or investor literature. All of them were in their mid- to late thirties, Eva guessed. If she had been required to put a number on them she would have said Garrick was the older of the group, but only by a couple of years. He had a preppie air about him, the same kind of playfulness she had sensed in Chatham. Eva could imagine him in tennis whites, bounding up to the net after a match. Nicola Milne was trim, with dark eyes and dark, wavy hair that brushed her shoulders. She wore a blue, almost black jumper with a roll-neck and long sleeves. Her trousers were figure hugging. For some reason the overall effect reminded Eva of a swimsuit. Milne had a fluidity to her movements that suggested that she too exercised regularly. Odie looked marginally the fittest of the three, but it was only an impression. He loo
ked like somebody who was involved in deals, although when she analysed her perspective on that she realised she had probably only thought it because he wore a white shirt and a tie. With brown, slightly long hair and a shadow on his chin that suggested he needed to shave more than once a day, Odie was the only one of the management team who did not appear to be directly involved with surgery.
‘Nice to meet you,’ Odie said. ‘A great shame about the circumstances.’
‘It is,’ Eva agreed as she sat down. ‘Is there anything any of you can tell me about the victims?’
‘I think I operated on two of them,’ Neal Garrick said. ‘I’ll be honest, I remember the names but not the faces.’
‘I performed the operation on Ms Stepanov,’ Chatham admitted. ‘I do remember her. She was quite effusive.’
‘It’s a bloody good lens,’ Odie told Eva. ‘Our patients’ comments are the most positive of any surgical implant I’ve ever seen. But no, apart from that I really couldn’t say anything about them.’
She sat for a while waiting for any other information. None seemed forthcoming. ‘Okay,’ Eva said at last. ‘Well, thank you so much for your time. I have the patient records so I won’t keep you now. Obviously, once we’ve gone through them there may be questions, so please don’t go anywhere you can’t be contacted. In the meantime, if anything does come to mind, please get in touch immediately.’
All four of them walked her to the door. She nodded her gratitude as she climbed into her car. She had the notes and she had the electronic information she had requested from Chatham. What else had she expected?
It was only as she pulled away that she caught Nicola Milne staring at her. It struck Eva then that during the short discussion in the meeting room, Milne had not uttered a single word.
Chapter Fourteen
Flynn and Raj sat in the incident room and pored over patient records. ‘He let you sit in?’ Flynn asked. ‘Wasn’t that gross?’