Heartbreaker: Love, secrets and terror

by Nick Louth

  After retrieving the specially-creased hijab, Zainab wrapped it around like the other one, but with more pinning to each side of the sheila underneath. Cantara’s face was wreathed in flowers, which swelled to encompass an imposing and puffy hair arrangement behind.

  ‘Hey, it’s the true khaleeji look. Devout, but trendy, from the beaches of Dubai to the esplanades of Alexandria!’ Zainab said.

  ‘That looks fantastic,’ said Cantara. ‘Thank you!’

  ‘I’m not finished,’ Zainab said. ‘Keep your face still.’

  As Cantara did so she felt the delicate touch of an eyebrow pencil tracing her brow.

  ‘Now open your eyes wide.’ Zainab’s breath was close on her face, and she could feel a delicious sensual concentration between them as she approached her with the eyeliner pencil. ‘Now close your eyes,’ Zainab said. Cantara now felt the smooth brushing of eye shadow on her eyelids. ‘Okay, open them!’

  Cantara looked in the mirror and saw herself transformed. Her regal headscarf, and the dark edging around her eyes served to deepen and intensify her expression.

  ‘You really are beautiful!’ Zainab said. ‘I dare you to walk around downstairs.’

  ‘No, I couldn’t,’ she said. ‘They’d all stare at me.’ And it was true. She felt so special and there was no-one but Zainab she could share it with. For the first time she felt a little like a prisoner in the musallah.

  ‘Then let’s go out,’ said Zainab. ‘Let London see you!’

  It hadn’t been hard to slip downstairs unawares. Though the front door was usually locked after 7pm, the back door which gave access to the madrassah and the car park was never locked until midnight. Zainab and Cantara stole out into the drizzle, and once they were out of the car park, changed into their high-heel shoes. They took a bus to Piccadilly Circus and stood by the statue of Eros, absorbing the dazzling lights of giant advertising displays that made this the glitzy heart of London. It was packed with people, mainly young, often drunk, and dressed for a night out. There were hustlers of one sort or another, tourists taking pictures, and some NHS staff by a trailer advertising safe sex, who were handing out free condoms.

  ‘If Dr Khan knew we were here he’d have a heart attack.’ Zainab laughed. ‘This is what he has always warned us against. Bright lights, consumerism, sexy men, glamorous girls and free contraceptives. But we’re adult enough to handle it, aren’t we?’

  It wasn’t long before two middle-aged Asian men approached them. One whispered in Zainab’s ear. Whatever he said seemed to horrify her, and she recoiled. ‘What was that?’ Cantara asked, after they had gone.

  ‘They wanted to buy us for the night.’

  ‘Ugh.’ Cantara said.

  ‘Let’s get a drink,’ Zainab said. ‘I need one.’

  Soon they were in a crowded pub, drinking over-priced white wine while a crowd of jeering white men watched football on a giant screen above their heads.

  ‘I’m dizzy with all this noise,’ Cantara said.

  ‘Me too. It’s fab!’

  With the rain now stopped, they wandered around the streets of the West End, looking at the shows and films that they couldn’t afford. After sharing a burger bought from a van, and a long bus ride home they got back to the musallah just before eleven. There was no sign that they had been missed.

  ‘That was great fun,’ whispered Cantara, as they climbed the silent stairs.

  ‘It’s a special celebration,’ Zainab said, as she helped herself to a carton of orange juice from the kitchenette. ‘I’ll get you a drink.’

  When Cantara was in the toilet, Zainab looked at her watch, and recalled the instructions she had been given. She opened a drawer and took two green capsules from a folded slip of paper. She poured a glass of orange juice, then dropped the two tablets into it. A quick stir, and the tablets dissolved, the bitterness lost in the sharp citrus taste which Cantara had always said reminded her of home.

  Chapter Twenty-Seven

  Berkshire

  England, July 2010

  Brampton Lane Hospital in Slough might easily be mistaken for a prison. Built in the nineteenth century as a women’s asylum, its two-storey red brick hallways radiated from a central castle-like tower from which sprouted four huge and crumbling brick chimneys, each decorated with faux gothic carvings. One chimney had vented the giant laundry, now disused. Another two rose from the furnaces and boilerhouse which had powered its heating. The final soot-scarred edifice vented the squat and grimly efficient crematorium which is still reserved for the use of the local authority in time of war. The hospital had been largely closed in 1957 after the Clean Air Act. Two things had prevented its redevelopment for West London’s housing boom. The grounds, which were consecrated for the burial of the miscarried infants of the unwed, and the chimneys, Grade I Listed and preserved against demolition. Instead over the years it had been reborn as a maternity unit, then a day care centre for the elderly, and finally an ambulance station before Westfield Primary Care Trust in 2007 had finally sold it to a private hospital group. This company had expected to make money providing orthopaedic services for knee and hip replacements for those who couldn’t wait their turn for the National Health Service, but had been caught out by an unexpected fall in queues.

  Brampton Lane’s struggling owners, therefore, were more than happy to rent out their small but modern operating theatre for a private operation to install a pacemaker. Particularly when the office making the booking was that of Mr Qaladar Tanoli, a consultant cardiologist at Hammersmith Hospital. With Dr Tanoli’s credentials, and the unusually high fee paid, the firm was more than satisfied that everything would be above board.

  They were wrong.

  Tanoli was the surgeon. But he wasn’t in control of the operation. And he knew it was illicit and unethical. It was undertaken outside all the guidelines of the General Medical Council which would almost certainly lead to him being struck off if it was ever discovered. His career could easily be destroyed. But had he refused his career would equally be at risk. The backers had somehow found out that his original medical certification from Karachi, a registration with the Medical and Dental Council of Pakistan, was a forgery. He had completed his studies but had failed his exams, having spent the two weeks immediately prior to them in police custody. As so often in Karachi, he was offered a chance to ‘re-take with a guaranteed top grade.’ There would of course be a fee. A substantial fee. Afraid to tell his parents of his failure, he instead borrowed the money, and paid the fee for a top grade. His entire subsequent medical career, both back home and later in the UK, though diligently executed, was built on a bed of lies.

  But the biggest worry now for Tanoli wasn’t the fate of his career. It was what he was being asked to do. When he arrived at the hospital the patient was already there, in the operating theatre on a trolley. She was a young woman, of Middle Eastern origin, in her early twenties, and she appeared already sedated. He didn’t know the first thing about her. When he had first been approached, he assumed that the operation would be for a wealthy Saudi or Gulf Arab, someone elderly with a long history of heart disease. Discreet operations in London are often undertaken privately for such people, who want the best and can pay for it. There are established, private but officially-regulated channels for such work.

  This was different, and in every sense irregular. Never before had he been asked to undertake an operation devoid of the information that any surgeon could expect to rely on. Though he was prepared for the patient’s anonymity, he had assumed that a medical history would be provided, ideally well in advance or at least verbally, by an accompanying private physician. But there was no accompanying doctor. There were only three other people there in the operating theatre. A male nurse, a young anaesthetist, and the Arab man with black gloves who had commissioned the work. There were even bigger failings too. After he arrived he discovered that even the essential preliminaries were omitted. She had received no chest X ray. No electrocardiogram. No echocardiogram. No lung fu
nction test. No BNP hormone test. As he told them, installing a pacemaker may in 2010 be a routine operation, but a human heart is a human heart.

  When he had asked to speak to the patient, to try to build some medical history, the man with the back gloves had firmly said No. No conversation with the patient is allowed. But somehow Tanoli needed to assert his clinical authority. The safety of the patient depended on it. This was not how any medical procedure should be undertaken. If something went wrong, if some important aspect of her past had been overlooked, he would have made a serious mistake.

  He had been grudgingly allowed to make a rudimentary physical examination. His stethoscope revealed the woman’s heart beat was irregular, but not dramatically so. It could be no more than the palpitations brought on by being in hospital. Her blood pressure was normal, and there were no signs of the swollen feet, ankles or abdomen which would indicate more enduring cardiac issues. With no medical history, Dr Tanoli knew he was missing something. This young women didn’t apparently need to have a heart pacemaker fitted at all. So why was she here? And why the secrecy?

  Watched all the time by the young man with the gloves, Tanoli began to feel that he had was making the biggest mistake of his life. He looked again at what he was expected to put into the patient’s abdomen. There was a heart pacemaker, something with which he was very familiar. It was a Medtronic device about the size of a fifty pence coin, with two wires designed to stimulate the heart ventricles. So far, so normal. But connected to it by a slim cable was a black pod, about the size of a mobile phone casing. Both devices were in polypropylene antibacterial pouches, which would gradually dissolve over time. What the ancillary device was, he had no idea. He had been told to mind his business and concentrate on his work.

  Normally a pacemaker would be fitted behind a collarbone, tucked into a small fleshy slot. But the size and weight of the black pod made that impossible. He had already been told he would be undertaking an epicardial implantation. In the abdomen under the heart, rather than above it. The pacemaker leads would be attached directly to the epicardium, the outer surface of the heart, and the device itself inserted below the layer of subcutaneous fat in the abdomen. That made it a much more substantial operation. A full anaesthetic rather than a local. A non-trivial risk of damaging vital organs. A non-trivial risk of infection. A great deal more blood spilled.

  Such procedures were not unusual when a pacemaker was being fitted as part of more general heart surgery. He had undertaken such procedures on a dozen occasions. Indeed, when he was in his first year of specialist training, he had been shown 1960s type pacemakers, as big as a large bar of soap and about as heavy. They were far too weighty to go anywhere else but in the abdominal cavity. Likewise, with this ancillary device. When he was first approached, he had been told that this mysterious device would weigh four hundred and seventy two grammes. More than a pound. The man with the black gloves announced that it was precisely the same weight as the pioneering Chardack-Greatbach implantable pacemaker of 1959, implying that this would therefore make it easy.

  Tanoli was amazed that his clients had done such research. But he also had to say that no current heart surgeons would have experience of placing such heavy devices in modern times. He would only be comfortable installing a device just over half that weight, especially when he asked the weight of the patient. A woman of just fifty kilos, possibly less. They had reluctantly agreed to modify the device.

  And here, right in front of him, it was. Tanoli picked it up, and hefted it. The weight did seem about right. He inspected the seam of the antibacterial pouch. For the final time he checked the instruments, satisfying himself that all preparations that could be made had been. From the kidney dish he picked up the scalpel and looked for the carefully-marked line on her abdomen. Finally, he raised the blade and pressed its keen edge against the yielding warmth of the young woman’s flesh. As he cut, dark red blood welled up.

  * * *

  Cantara gradually emerged as if from a daydream into a high-ceilinged blue-painted room. Something reassuring, some aroma that made her think of home. Oranges. There was a bowl of them by her bed. It was dark outside, and she didn’t know what day it was. Was this late night or early morning? The shadows of dreams clouded her mind. She remembered being in her room, and then collapsing and Zainab calling for an ambulance. A nurse was wiping her mouth, and then she saw Zainab there by the bed, holding her hand. There were voices. A tall doctor, wearing a white coat told her something about having had an emergency heart operation. She was too groggy to take in what he was saying, but she liked seeing his smile, which reassured her. Words fell from his mouth. Arrhythmia. Pacemaker. Nothing to worry about. A small device inserted into her tummy. Might be sore for a few days. Rest. Nothing to worry about.

  Then he left. Cantara tried to speak, but her tongue was thick with sleep. She remained confused and uncertain, even as Zainab and the nurse lifted her gently into a wheelchair, then wheeled her out along a long corridor which smelled of disinfectant. Doors beyond led out into the cool night, along a bumpy path. The rattling movement generated a tight sore pain in her stomach. A minibus was waiting, with its engine running and a disabled lift at the back already down. By the bus she saw Rifat, who smiled at her. And Bram, who was sitting in the driving seat. Everyone was smiling. How nice. For some reason, seeing how many of her friends had come to see her and wish her well, tears began to roll down her face, and as she was driven back across west London to the musallah, she began to think how wonderful it was to be amongst people who cared for her. Among people who had become like a family.

  * * *

  For the next few days, Cantara lay in bed in her room, while Zainab popped in regularly. Her initial worry on coming to her senses was how she would pay for the operation. But Zainab and Bram had assured her that in the land of the National Health Service, such emergency procedures were always covered by the state. In private moments, when Zainab wasn’t with her, Cantara would slide down her pyjamas and feel around the dressing on her tummy, sliding her fingers as close to the scar as she could without tearing off the dressing. Everything felt very full down there, as if she’d had indigestion, and the wound pulled painfully unless she moved with great care. She had been told that it would ease.

  But the biggest shock to her had been to discover that something was wrong with her heart. Something that had required her to have this emergency operation. Something that might forever limit her physical energy. Something that would probably mean she could not undertake important work for Irfan Tiwana. She was surely too young for these old people’s problems. During all these anxieties and worries, Zainab was a reassuring presence. She lent Cantara her iPod, combed her hair, and cooked her delicious meals. Cantara enjoyed watching her roommate praying, the full salat every day and night, trying to match the melodic susurrus of her chanting, but often falling asleep.

  * * *

  Today, in the privacy of his father’s London apartment, the black gloves were off. The scarred skin on the back of Rifat’s acid-burned hands was unbearably itchy, a sure sign of his growing excitement.

  There was plenty to be excited about. The tracking device inside Cantara was working perfectly. Though she was moving little, it was possible from his laptop to track her movements within the musallah, inside the student house and walking across the car park between the two. If Cantara showed no ill-effects after another week, the green light would be given to finalise the training of all the other martyr candidates, painstakingly recruited across Europe and the Middle East over the past year.

  The beauty of the plan that he and Irfan Tiwana had come up with was one that would fool all the usual techniques of the intelligence services. Although all these volunteer students were Muslims, not a single one was a jihadi, or even had radical views. None had ever been to a training camp in Pakistan or Yemen. None had a criminal record. None of them knew any of the others. All of them, twelve women, and seven men, would be booked on separate flights to cities acr
oss the world, to visit genuine Islamic communities, mosques or conferences. These flights were to coincide with the start of the Middle East peace conference in February 2011. Each of the martyrs in turn would be given drug-induced arrhythmia and have a private operation at Brampton Lane Hospital under Qaladar Tanoli. Once the surgeon had done his work, each of them would be a walking, talking, living bomb entirely unaware that they could be detonated by a single text message sent from the other side of the world.

  Book Five

  Chapter Twenty-Eight

  Cairo

  December 2, 2010

  Getting permission for Wyrecliffe to see Cantara’s body was a thankless bureaucratic task. Despite gracious and persistent help from the BBC’s Cairo bureau, interventions from British consular staff in Egypt, and some subtle diplomatic leverage on the Egyptian embassy in London, it had taken two weeks since the bombing to make any progress. The Egyptian authorities made it clear that until the investigations were complete, no one without high-level clearance would be allowed into the secure military mortuary where the bodies of the 176 dead were being stored.

  So when Wyrecliffe arrived, tired and frustrated, on a delayed EgyptAir flight from Heathrow to Cairo, he didn’t know what to expect. An interview had been granted, with Air Vice-Marshal C. Q. A. Sawalha, a senior air force officer, who was in overall charge of the investigation, and who alone had the power to grant a viewing of the body. No promises were made. Wyrecliffe would only have one shot at this, so he was glad that he had finally tracked down Cantara’s Aunt Fatima and Uncle Walid in Homs, in the western end of Syria. They would provide the humanitarian excuse for a chance to say goodbye to their long-lost niece, the child they had brought up in extraordinarily trying circumstances.