“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.”
“Well, okay. Holly, how about popping in that Bob Marley CD?”
“You got it,” Holly said. “It is a reggae kind of morning at that.”
“Come on, robot,” Jessie cooed. “Please don’t fail me now. Skip, we’re going in.”
Jessie made a half-inch hole through the back wall of Malloche’s nostril, cauterized the bleeding, and guided ARTIE through the opening and into the cranial cavity.
“Hans, are you ready to show me some views of this tumor?”
“It’s on the screen right now. Quite an impressive lesion. Manipulate the orientation with your foot control as you wish.”
The views were perfect. And, as Pfeffer had observed, the tumor was extensive. Thanks to the transnasal entry, ARTIE was already just a centimeter and a half from it. A standard, non-robot approach would have presented a hideous technical problem, and would have undoubtedly destroyed some—maybe a good deal—of the uninvolved brain tissue. Once again, Malloche had justified his reputation for genius. There was no way Sylvan Mays could have promised a total excision with no residual neurologic deficits. Malloche must have gotten him to admit that before he killed him. With ARTIE, there was a very good chance.
The guidance system for the tiny robot was as smooth and responsive as Jessie could ever remember. Still, she held back, progressing much slower than she needed to, stalling in hopes that Mark Naehring might still show up. But with each passing minute, that hope diminished. Maybe Tamika had never gotten that final message through before the laptop was destroyed. Maybe Naehring couldn’t be located. Whatever the reason, Jessie knew she was going to have to find another way, or else give up on her plan and simply pray that Malloche would recover from his surgery intact and head home, sparing the hospital and the city.
“Skip, ARTIE’s working beautifully,” she said as she manipulated the unit until it was positioned a
t the very edge of the meningioma.
“I did some tinkerin’,” the scientist said. “Besides, ARTIE likes you. It always performs well for people it likes.”
Just then, through the intercom, Jessie heard an exchange of voices.
“Naehring. I’m Dr. Mark Naehring. I’m here to—”
“I know why you’re here,” Derrick said. “Go on in.”
Jessie rose on tiptoe to see over Emily. Naehring, who looked taller than she remembered, went directly to the scrub nurse’s area, opened a Ziploc plastic bag, and dropped several vials out.
“They’re sterile,” he said.
“Do you want gloves and a gown?” the nurse asked.
“Yes.”
There was something about Naehring’s voice …
Jessie was straining to get a better look, when the man, now in his surgical gown, turned toward her.
Alex!
CHAPTER 35
JESSIE CONTINUED HER ULTRASOUND DISSECTION and aspiration of Claude Malloche’s tumor as Alex took Emily’s place at the table.
“I’m glad you could make it, Dr. Naehring,” Jessie said, her eyes asking a dozen questions at once.
“Mark’ll do fine,” Alex replied.
“Okay, Mark. I’m glad you could make it. Holly, is everything okay out there?”
Jessie used the question to be certain Alex knew they were being monitored.
“Everything’s fine,” the tech said. “Why?”
“The MRI image seems a little grainy, that’s all.”
“I’ll check on it.”
Jessie switched off the microphone.
“The microphone’s off,” she whispered, still working ARTIE through Malloche’s tumor. “But I can’t keep it that way for long. The woman behind me is one of them.”
“I know.”
Jessie turned the microphone back on, straightened up, and worked some of the stiffness from her neck. In addition to the tightness in her muscles, she felt her touch on ARTIE’s controls was getting a bit heavy. And although the Marley album might be making it easier for them to talk, it was also beginning to grate on her.
Easy, she warned herself. Relax, stay focused. No screwups.
“Holly, we’re getting down to the nitty-gritty here,” she said. “How about switching to Rhapsody in Blue?”
“Rhapsody in Blue coming up.”
Jessie waited for the music change, then switched off the mike again. “Now, what on earth are you doing?”
“Naehring’s at a conference in Maui. It took most of the night for us to track him down. Once I learned what he did, I realized how brilliant your idea was.”
“What good does that do?”
“He told me where to find his potion and how to use it.”
“Over the phone?!”
“I’ve—um—had a little training in the area.”
Out of the corner of her eye, Jessie became aware of Grace, who had shifted over a few inches.
“Michelle,” she called out, switching the sound back on, “everything looks great. Any problems?”
“None. I’m here elucidating some of the finer points of anesthesia to Nurse DelGreco.”
Finer points of anesthesia. Hardly likely, Jessie thought. The notion made no more sense than her elucidating some of the finer points of neurosurgery. Michelle was telling her that Emily had found some way to communicate more of the situation to her without calling attention to them. Excellent.
“Well, Mark,” Jessie said, “the dissection is going fine so far. Hans, can you put up the pre-op screen? … Great. Mark, the yellow is his meningioma before we began. Back to the current screen now, Hans.… And this is what’s left of the tumor as of this moment.”
“Nice job,” Alex said. “Very nice. This is one lucky guy.”
He patted Malloche on the head as if he were a puppy. Jessie’s eyes flashed a warning and directed him up to the overhead camera that was monitoring the operative field for Derrick and the others.
“Michelle,” she said, “maybe seven more minutes and we’re going to wake him up.”
“We’re ready, Doc. This Gershwin’s great. I never remember you playing it before.”
Mike off.
“Grace, the woman behind me, and Derrick, the guy outside, are both armed,” Jessie murmured. “Malloche had a nonmagnetic gun made for her.”
“Well, isn’t he something,” Alex replied. “Tamika went off-line. Is she okay?”
“For now. They smashed her computer, though.”
Mike on.
Jessie continued to guide ARTIE flawlessly, liquefying Malloche’s tumor with ultrasound, then aspirating the melted cells and debris through the robot’s suction port. The heavy core of the tumor—60, maybe even 70 percent of it—was gone. They were in uncharted waters now. Gilbride’s success with Marci Sheprow’s uncomplicated, superficial tumor notwithstanding, they were clearly beyond where Jessie had taken ARTIE on the cadaver of Pete Roslanski, or where Carl had come apart in the ill-fated operation on Rolf Hermann. The complexity of the dissection ARTIE was accomplishing here was justification for the hundreds of hours she had spent at the drawing board and in the lab. If only the patient were someone she wanted to cure.
“Well, gang,” she said, “it’s time to get ready for the hard part. Michelle, please go ahead and start waking Mr. Tolliver up. We’ve got this thing about seventy percent gone. The next thirty will take us a while. Mark, let’s take our time.”
Mike off.
“You sure about this?” she asked.
“Of course not. But Naehring spent almost an hour on the phone with me. The stuff I’ll be using came from his office. It’s all mixed—four drugs in just the right proportion.”
“What are they?”
“Scopolamine, Pentothal, I think.… I can’t remember the other two. Jessie, I’ve been screwing up right and left ever since I learned about Gilbride using this robot, here. I’m not going to mess this up.”
“Good luck, Alex.”
Mike on.
“Michelle,” Alex said, “if it’s all right with you, I’d like to handle the meds myself, from right here.”
“There’s an IV port under the drape just next to your right hand, Doctor,” the anesthesiologist replied. “It’s sterile. If there’s anything I can do, just say the word.”
Jessie took a step back—out from between the tori—and turned to Grace.
“Things are going very well so far,” she said.
“I can tell,” Grace said. “That’s good. That’s very good.”
Jessie stepped forward, once again positioning herself to block the young killer from Malloche and Alex.
“Doctor Naehring, he’s all yours,” she said. “For the time being, ARTIE and I will be dissecting around the left motor cortex. I need the patient to keep working his right hand and foot. Michelle, you can see his feet, yes?”
“They’re right here.”
“Perfect. Mark, would you prefer music or none?”
“Music, most definitely. What you have on is fine. I want him wide awake, Michelle. Then I’ll bring him back down again myself.”
Jessie’s eyes smiled across at him. Claude Malloche, mythologized as the Mist, killer of so many, wide awake with his head screwed to an immobilization frame, a half-inch tube up his nose, through his skull, and into his brain. Not the full payback Alex wanted, but certainly a sweet, sweet ante.
“Mr. Tolliver,” Jessie said, “it’s Dr. Copeland. Can you hear me?”
“I can,” Malloche rasped.
“The operation is about three-quarters done, and everything is going perfectly.”
“Good.”
“As I told you, we’ve got you immobilized so you can’t move your head. But you can move your hands and feet. Shake your right hand for me, please.… Good, good. Now your left … excellent. Your right foot?”
“These little piggies went to market,” Michelle called out.
“Now your left foot.”
&nbs
p; “These little piggies had roast beef.”
“Terrific. Now, the tube you feel in your nose is ARTIE, the tiny robot. Do you understand?”
“Yes.”
“You may feel some movement or vibration as I guide ARTIE further into the tumor. We’re going to medicate you a bit more so that we can keep working without causing you too much discomfort. You’ll hear commands from me or from Dr. Mark Naehring, who’s right there on the other side of you. Just do whatever it is we ask. Some commands will be given in a loud voice, some will be softer. Sometimes we’ll ask you over and over to do the same thing. That’s how I’ll be able to monitor things if I’m working close to a vital area.”
“Understand,” Malloche said.
“Good. You’re doing great, Mr. Tolliver. Just great. Ready, Mark?”
“Ready. Could I have five ccs of the mixture in vial number one, please?”
“Five ccs,” the scrub nurse said, passing the syringe over.
“Half a cc, then wait one minute,” Alex said. “Mr. Tolliver, lift your right hand. Good. Do it again. Once more.” He bent down closer to Malloche’s ear and nodded for Jessie to cut the mike. “What’s your name?” he whispered harshly. “… Your name!”
“Claude … Paul … Malloche.”
Jessie glanced behind her to see if Grace had heard. She was nodding her head to the Gershwin piece.
“Move your right foot,” Jessie ordered after keying the mike again.
“Okay,” Michelle called out.
Jessie cut the mike and nodded to Alex. He tested the dose level with several inane questions about Malloche’s birthplace and parents. On the fourth go-round with the mike off, he was ready.
“Soman,” he said. “Do you know what I’m talking about, Claude?”
“I … do.”
“How many vials are there hidden in Boston?”
“Three … four …”
“Which? Three or four?”
“Three … four.”
Jessie raised her hand for Alex to stop and once again checked on Grace.
“We’re still doing terrific,” Jessie said over her shoulder.
“Keep it up,” Grace replied.
You bet! You bet we will!
“Take your time, Mark,” Jessie said.
The Patient Page 28