by James Hayman
Spencer looked even younger than McCabe expected and handsome enough to play a doctor on TV as well as in real life. He was tall and slender, his straight dark hair beginning to turn gray. His face and manner exuded WASP breeding. His deeply tanned skin suggested a lot of time spent either outdoors or in tanning salons, and McCabe didn’t see him as a tanning salon kind of guy. He was dressed in surgical scrubs.
McCabe glanced around. There was nothing out of place. The items on Spencer’s desk were precisely arranged. Medical journals on the coffee table were stacked in date order, no untidy edges sticking out. Photographs of Spencer, sometimes alone, sometimes with others, lined one wall. In several he was wearing scrubs, as he was today, standing with people McCabe assumed were grateful patients, happy to be leaving the hospital alive, new hearts beating, their leases on life, at least for the moment, renewed. In one photo Spencer was dressed in black tie and flanked by former president George H. W. Bush, Barbara Bush, and Maine’s Senator Olympia Snowe. A banner behind them indicated they were celebrating the twenty-year anniversary of the Levenson Heart Center.
To McCabe, the most interesting of the photos showed Spencer, maybe ten years younger, dressed in climbing gear, posing for the camera with a group of three other men all about the same age. A hand-lettered sign in front of them read DENALI SUMMIT. ALT: 20,320 FEET. WE MADE IT! Three of the climbers were smiling proudly into the camera, but Spencer’s face was turned away. He was standing second from the left, his eyes focused on the man standing next to him. McCabe thought there was something unexpected about Spencer’s expression. He couldn’t quite figure out what it was.
He scanned the rest of the framed photos. Interestingly, there were no shots of the doctor’s wife. None of family vacations. None of Spencer children, if any such children existed.
McCabe turned away from the photos and looked through the windows behind Spencer’s head. Far in the distance, he could see the distinctive triangular shape of Mount Washington silhouetted in the last of the sun’s setting rays. ‘Pretty spectacular, isn’t it?’ Spencer said, hanging up the phone. ‘One of the rewards of being on the top floor.’
He pushed some papers into a folder, flicked on his desk lamp, and leaned back in his chair. The light accented the shadows of Spencer’s deep-set, nearly black eyes as they studied McCabe. ‘Sorry about the delay,’ he said. ‘Now, how can I help you, Detective?’
‘What do you know about Katie Dubois’s death?’
‘Not much. Basically what I read in the paper last week after her disappearance. Katie Dubois was a sixteen-year-old high school girl from Portland. She was a good athlete. A pretty blond. She vanished after a night out in the Old Port. Last night Tom Shockley told me she’d been murdered.’
McCabe stiffened. ‘How do you know Shockley?’
‘We go to the same parties. That’s where we were last night. At a fund-raiser for Kids with Cancer at the Pemaquid Club.’
The Pemaquid Club was a tony in-town watering hole for Portland’s rich and well connected. It was housed in an elegant redbrick Georgian mansion on the city’s West Side. McCabe doubted there were many cops among its membership rolls.
‘What else did he tell you?’
‘Not much. We were having a drink together at the bar when he got a call about the murder. I could only hear his end of the conversation, so I asked him what’d happened. He said the girl’s body was found in that scrap yard on Somerset. Naked. Cut up. Maybe raped. Then he took out his phone again and called you and left a message. He said you’d be running the investigation and that he had a lot of confidence in you. That’s it. All I know.’
‘Did you watch Shockley’s news conference this morning?’
‘Afraid not.’
‘What I’m about to tell you is confidential.’
‘I understand.’
‘Katie Dubois died because her heart was cut out of her body.’ As he spoke, McCabe watched Spencer’s face for signs of reaction. All he saw was a mild curiosity.
‘Removing the heart was the cause of death? It wasn’t done postmortem?’
‘No.’ McCabe told Spencer most of what Terri Mirabito had said about the cause and manner of Katie’s death, leaving out any mention of ligature or burn marks. Or of rape.
‘Dr. Mirabito’s right. Removing a heart is not that difficult. Not if you’ve got the proper tools – a scalpel, a reciprocating saw to cut the sternum, a retractor to spread the ribs. Pretty much any surgeon could do it, certainly any cardiac surgeon.’
‘Why do you think the murderer – whoever it was – might have wanted to cut out her heart?’
‘Me? I haven’t a clue. We both know there are all kinds of crazies in the world. I suppose some of them could be doctors. It was probably something sexual. From her picture, Katie was an attractive girl. People express their sexual fantasies in strange ways, but psychiatry’s not my field of expertise.’
‘You’re a transplant surgeon, right?’ asked McCabe. ‘You remove hearts for a living?’
‘Not exactly. I’m head of the transplant program here at Cumberland. The goal is to give people new hearts. In each case to save a life. That’s what turns me on. Harvesting – organ retrieval – is more often than not somebody else’s task.’
‘What’s it like? Cutting a heart out of a living human being? For a heart surgeon, is it simply all in a day’s work, or is it something somebody might get off on?’
‘You mean sexually?’
‘Yes.’
‘I don’t know. I can tell you it’s never all in a day’s work. Even when you know the heart will be used to save another life. On one level, the human heart is nothing more than a muscle that works like a small pump. Weighs less than a pound. Only a little bigger than your fist. Yet it beats a hundred thousand times a day. Pumps a couple of thousand gallons of blood. Unless we go out of our way to screw it up, it will, most likely, keep on doing that every day for seventy, eighty, even ninety years, often without routine maintenance. Show me another machine that can do anything like that.’ Spencer sounded genuinely excited.
‘You said on one level. What’s the other level?’
‘The other level is spiritual. Ancient people believed the heart was the seat of the soul. Some of us still do. When I do remove a heart, sometimes I hold it in my hand for a minute or two knowing it will give new life to a dying patient. An extraordinary feeling. Today, though the legal definition of death is death of the brain, some people still believe the soul resides, at least partly, in the heart.’
‘Are you one of them?’
Spencer smiled. ‘That, Detective, is my secret.’
‘You’ll be doing a transplant tonight?’
‘Yes. I’m waiting for a heart to be harvested in a hospital in New Hampshire sometime this evening. When it gets here, I’ll be putting it into the body of a forty-five-year-old high school teacher with a wife and two children. Without the transplant, he’d be dead before the end of the year.’
‘Do you think Katie Dubois might have been killed to harvest her heart for a transplant?’
Spencer looked up. ‘You mean as part of some sort of black market in organs?’
‘Yes.’
‘The answer is no.’
‘Why not?’
‘Couldn’t be done.’
‘You said yourself removing a heart wasn’t that difficult.’
‘It’s not. Any reasonably well-trained surgeon or pathologist can do it easily. Harvesting the heart isn’t the problem.’
‘So what is the problem?’
‘There are a lot of problems. For starters, there isn’t a transplant facility anywhere in this country that would accept a harvested heart without knowing precisely where it came from and under what circumstances the donor died, or without the participation of an organization called the United Network for Organ Sharing, which works through various regional OPOs – organ procurement organizations.’
‘That’s where you get your harvested hearts?’
‘How does it work?’
‘When a heart becomes available, let’s say somebody is injured in an auto accident, they’re taken to the nearest hospital, which is probably not a transplant center. Then a lot of ifs come into play. If the patient dies and if the heart is healthy. Or if the patient is brain dead and if the heart is healthy. If the hospital’s trauma team can get permission from the victim’s family to harvest the organs. If all those ifs fall into place, the hospital informs the New England Organ Bank and prepares to harvest all usable organs, including the heart.’
‘Who decides who gets the heart?’
‘On any given day, the New England Organ Bank has a backlog of approved transplant patients waiting for hearts or, in some cases, for a heart-lung combination. Those who’d die first are at the top of the list. Geography is also a consideration. You don’t want the heart traveling any farther than it has to. Time in transit is an enemy to a successful transplant. When that’s all sorted out, the heart’s offered to the highest-priority patient with the right blood type and compatible tissue located in the nearest transplant center. Right now, today, there are over twenty-five hundred very sick people in the United States waiting for hearts. Many if not most of them will die waiting.’
‘An ideal situation for a black market, wouldn’t you say?’
‘For the sellers, sure.’
‘Also for the buyers,’ said McCabe. ‘You just said yourself a lot of people die waiting. Wouldn’t a few of them be willing to pay a substantial amount for a chance to jump the queue?’
Spencer paused for a minute, studying McCabe. ‘I’m sure they would,’ he said in a considered voice, ‘but who’s going to perform the transplant, and where? Any recognized transplant center would be crazy to even think about it. So would a qualified surgeon. The operation can’t be done by a surgeon acting alone, no matter how skilled or experienced, and it can’t be done on a kitchen table. When I transplant a heart, there are ten to twelve specialized people in the OR. All critical to the procedure. Plus a lot of sophisticated equipment. Most important is a heart-lung machine and a perfusionist to run it. The heart-lung machine circulates and oxygenates the patient’s blood and keeps him or her alive between the time the sick heart is removed and the healthy heart goes in and begins beating.’
‘What else is required?’
‘What else?’ Spencer shrugged. ‘A diagnostic lab to perform pre-op and post-op tests. A well-stocked blood bank. A facility for postoperative recovery and one-on-one care for at least a few days. You need an array of monitors. You need someone to prescribe and administer antirejection drugs and to watch the patient for signs of infection due to a compromised immune system. You need to be able to follow a fairly rigid postoperative protocol. I just don’t see how some kind of rogue surgeon could put all that together on his own.’
‘How long is a living heart viable after it’s harvested?’
‘Not long. Four or five hours. Our heart in New Hampshire will be placed in an iced saline solution in an ordinary picnic cooler, put on a helicopter, and flown directly here. While that’s being done, we’ll remove our patient’s diseased heart and attach him to the heart-lung machine until he receives his new heart. It’s all very tightly coordinated.’
Four or five hours. Terri Mirabito estimated Katie’s time of death as forty-eight to seventy-two hours before Lacey found her in the scrap yard. Since her body was found around 8:00 P.M. Friday, a transplant would have to have taken place sometime between 8:00 P.M. Tuesday and 8:00 P.M. Wednesday. Twenty-four hours. A big window.
‘How long does a transplant operation take?’
‘Depends how complicated. Anywhere from four hours to a whole day.’
McCabe resisted the temptation to ask Spencer where he was between Tuesday night and Wednesday night. Or Thursday while the body was being dumped. He had no evidence whatsoever that Katie Dubois’s murder was anything other than a random attack by a sexual sadist. McCabe found Spencer’s manner annoyingly arrogant but he had nothing aside from the fact that he was a cardiac surgeon to implicate him one way or the other.
‘How many other surgeons are on staff here at Cumberland? How many other cardiac surgeons?’
‘There are twelve of us in the cardiac unit. Another hundred or so in other specialties or practicing general surgery. I’m not sure of the exact number.’
‘How many do transplants?’
‘Myself and two others. James Puccio and Walter Codman.’
‘Could you get me a list of the other surgeons’ names and contact info? Or shall I get that from a hospital administrator?’
‘Detective, I seriously doubt any surgeon on the staff of this hospital is leading a double life as a sadistic killer of teenaged girls. We’re pretty damned careful about who we bring on board.’
‘I appreciate the sentiment, Doctor, but the evidence suggests we’re looking for a surgeon, and this is one of the places surgeons work. Especially surgeons with an interest in the heart. I’ll also be checking with other hospitals.’
Spencer pursed his lips. ‘Very well,’ he said after a moment. ‘I’ll have my assistant get you a list of the names.’
‘Thank you. I’d also like bios and résumés.’
‘Sorry. I’ll give you names, but that’s it. No CVs or other personal information. There are serious privacy issues involved. If you want to know more, you’ll have to talk to each of the doctors individually.’
As Spencer spoke, an image flashed in McCabe’s mind of Lucinda Cassidy, strapped to an operating table, Philip Spencer leaning over her, ready to cut. ‘Dr. Spencer, time is critical here,’ he said. ‘The more we spend chatting with your staff, the colder the trail will get. It would save us a lot of time if you would help.’
‘Sorry. No.’
‘I can get a court order, if I have to.’ McCabe wondered if the doctor knew he was bluffing. Getting a court order from any judge to go rummaging through the personal backgrounds of more than a hundred respected doctors might be a tall order.
‘Then that’s what you’ll have to do. I’m not giving you access. You can always try HR, but I don’t think you’ll have any better luck there.’
He thought about the murder of Elyse Andersen. ‘Any of your surgeons move here from Florida in the last couple of years? Orlando maybe?’
‘You’re starting to annoy me, Detective.’
Spencer’s patience was wearing thin. McCabe decided to drop the issue, at least for now, and try another tack. He glanced again at the Denali picture and again was struck by Spencer’s expression. What was it?
‘I see you’re a mountain climber,’ he said.
‘I’ve done some climbing, yes. Denali, as you can see. Logan in Canada, El Pico de Orizaba in Mexico, Katahdin here in Maine.’
Was Spencer relieved to be changing the subject? McCabe wasn’t sure. ‘Those other guys are friends of yours?’
‘Old friends. We all went to medical school together. We did residencies together. All but one in cardiac surgery, then transplant surgery. At the time, we called ourselves, a little arrogantly I suppose, the Asclepius Society.’
‘Asclepius?’
‘Yes. After the Greek god of healing. Asclepius was so skilled a physician he could actually bring the dead back to life. That’s what we thought we would be doing as transplant surgeons. Bringing the dead back to life.’
McCabe remembered the story from classics class at St. Barnabas. Instead of being pleased with the healer, Zeus became so angry with Asclepius for co-opting the ability to bestow immortality that he slew him on the spot. Seared him with a lightning bolt, like an ancient Tony Soprano.
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nbsp; ‘How about you?’ asked Spencer.
‘How about me what?’
‘Are you a climber?’
McCabe thought back to his muddy descent down the slope of the Western Prom. ‘No. I’m definitely not a climber,’ he said. ‘It’s not anything I’ve ever thought about doing.’
‘Maybe you should.’
‘I can’t imagine why.’
‘Well, I could give you a lot of rigmarole about healthful exercise, but I’ve always thought the best answer to why anyone climbs mountains was George Mallory’s. Mallory was a British climber who tried an ascent of Everest back in 1924. He wanted to be the first man to reach the summit. When people asked him why he was determined to make a climb most considered impossible, and some thought suicidal, his answer was “Because it’s there.”’
‘That’s why you climb? Because it’s there?’
‘That’s why any serious climber climbs. Climbing is physically demanding. It can be dangerous. It can’t be called fun in any conventional sense of the word. It forces me to push myself further than I ever thought I could. Test myself. Find out how good I am. To me, and others like me, pushing the limits of our skill is what makes life worth living. It’s always exhilarating. Either hanging from a precipice twenty thousand feet up or cutting open a human being and replacing a heart in an operating room. That sense of exhilaration is what led me into transplant surgery.’
The word ‘risk-taker’ popped unbidden into McCabe’s mind, and he wondered again where Spencer was at the critical times. ‘I gather Mallory didn’t make it,’ he said. ‘Edmund Hillary and Tenzing Norgay were the first to climb Everest.’
‘Yes. Thirty years later. In 1953. A New Zealand bee-keeper and a Nepalese Sherpa. Mallory tried and died in the attempt. The equipment available to him in 1924 wasn’t up to the task. Everest is easier today because of modern equipment. Not easy, but easier. I’m curious. Isn’t there anything you do to test your own limits? To see if you can? Because it’s there?’