The Last Surgeon

CHAPTER 30

“We’re in.”

To Nick, Reggie’s words were all he wanted to hear. The Singh Medical Spa and Cosmetic Surgery Center held secrets, dirty secrets. He felt certain of it. Now, thanks to Jillian, they might have the means to prove it. Much as Nick wished that Buddha’s road to the truth was just a stroll down easy street, he had long known better. There was plenty of risk and disappointment, pain, and even death along the way. But now, there was hope.

Once again, Nick, Jillian, and Junie stood behind Reggie and his well-worn swivel chair. It took the teen hacker all of five minutes to access the computer on which Jillian had installed a rootkit. She recognized the desktop configuration now displayed on Reggie’s computer monitor as belonging to Paresh Singh.

“That’s amazing,” she said.

“With the rootkit, we can access that computer from right here,” Reggie said, “same as if we were sitting in his office.”

“Won’t they see us moving the cursor around?” Nick asked.

“Stop your worrying, Dr. G. It’s a zombie computer now.”

“Oh, that makes me feel so much better. But won’t they notice their PC eating the flesh of the living?”

Reggie laughed. “That’s a good one.”

“Once in a blue moon, I’m funny,” Nick said. “But this might not be it. What the heck is a zombie computer?”

“Well, basically, it’s just a computer that’s been compromised by a hacker, but the owner isn’t aware it’s being used by anybody else. The only clue they’d have is an unfamiliar IP address appearing in their access logs, provided they even had a reason to look.”

“IP address?” Jillian asked.

“It’s like a phone number for the Internet,” Reggie explained. “It can be traced to a home computer, same as your phone number can be traced to your address, or wherever you’re calling from. That’s how I got caught the last time, if you want to know the truth. But I think I know what I did wrong.”

“Reggie!” Junie said.

“Okay, okay. Just to be safe, though, I’m using a proxy to access the machine so nobody can trace the IP address back here.”

“Oh, I feel so much better now that you’ve explained,” Nick said. “Junie, how old did you say this terror on two legs was?”

“Too old and not nearly old enough,” she answered, bringing her fist down lovingly on the teen’s head.

Jillian leaned in closer.

“So what we’re looking at now is actually Dr. Singh’s computer desktop?”

“Yup. Thanks to you, we’re in control of his machine. For the time being we can access whatever applications Singh can, using his security credentials.”

“Amazing,” she said again.

“Not really. Computers get way too much credit-usually from people who don’t know how they work. Still, you have to know what you want them to do. Do you?”

“I think so,” Jillian said. “I didn’t have time to see what application they use for their electronic medical records, but seeing how they are a joint venture with my hospital, I’ll bet they use the same software we use at work. May I?”

“Be my guest.”

Reggie bowed to Jillian and motioned her to his chair. She bowed back respectfully and took his place. A connection had formed between the two of them. Nick had noticed it before.

Jillian went straight to the applications menu.

“I feel like I’m fifteen, sneaking out of the house to see my boyfriend.”

Nick, too, felt the thrill of the illicit-the adrenaline coursing through him as they closed in on secrets they were never meant to know.

“Do you see the EMR program?” he asked.

“Yes! This is it. It’s the same application we use at Shelby Stone. Eat your heart out, Mollender.”

Having been in one of the first groups trained on the software, Jillian was easily able to navigate through the various screens and prompts.

“Okay, from here I can search records by year. I’ll start from four years ago until now, yes?”

“Beginning in April. You got it,” Nick said.

He crouched low beside her, breathing in the intoxicating scent of the woman who, without his permission, seemed to have set up permanent residence in his thoughts. Jillian worked the application effortlessly.

“Okay, so it looks like the clinic has a database of about twenty thousand patients.”

“Is that substantial?” Junie asked.

“Not for a major hospital like Shelby Stone, but for a private practice it certainly is. According to this billing summary tab, the medi-spa’s gross income last year alone was over twenty-five million.”

“I’d call that respectable,” Junie said. “Just wait until next year’s Helping Hands fund-raiser. I think Dr. Singh will enjoy getting to know me.”

“Fear the Junie,” Nick said. “Listen, guys, we’ve got to keep moving. It’s possible someone could stumble onto the strange IP number, right, Reggie?”

“Ladies and gentlemen, he can be taught.”

“You wait, Smith; the next pass I throw goes right through your chest. Jill, can you search by name?”

“Of course.”

“How about we start with Manny Ferris first.”

Jillian typed “Manuel Ferris” into the designated search box. The query returned no records. Subsequent searches using variations of his name also yielded no results. The same was true when she tried “Umberto Vasquez,” and even “Belle Coates.”

“Dead end,” she sighed.

Damn, Nick thought. Mistakes on the road to truth… Number three, not possessing a backup plan, and number four, not bringing along hiking boots.

“We had no right to think we’d hit it on the first try,” he said. “Let’s get a look at all those records.”

“Um, listen,” Reggie said, “it may be hard to detect our IP address, but it isn’t impossible. Fifteen or twenty minutes, then we can try another time.”

“Got it,” Jillian said.

She switched screens and quickly filled in the required fields to generate patient reports from four years ago. The request took only a minute to run and when it did, the system returned a list of more than five thousand entries.

“Looks like every patient that walked through the doors of the place,” Junie said. “That’s a lot of information. Forget about fifteen or twenty minutes. We could be here for days.”

Damn, Nick thought again.

The screen displayed one record per row, listed by patient name, ID number, and ICD code. The ICD code, or International Classification of Diseases, Jillian explained, was used by physicians and hospital data entry personnel to label patients’ diagnoses such that procedures could be itemized and billed appropriately.

Five thousand entries for one year at the Singh Center.

“Each record is a mouse click away from more detailed information,” Jillian said. “Physicians’ notes, photographs, X-ray images, plus procedures performed, products used, and amount billed. Every scalpel, every box of gauze pads, every IV bottle. They’re all here.”

“Incredible,” Nick said, not bothering to mask his discouragement at such a vast amount of data on such a vast number of patients.

“Welcome to the wonderful world of electronic medical records,” Jillian said.

“Try the first one just so we can get an idea of what things look like.”

Without gathering any information on the patient in row one, Jillian clicked on the image tab and opened a photo of the frontal torso view of a naked woman. Reggie caught sight of the picture before she could remove it and quickly leaned in for a better look.

“Darn, but that chick’s got some mighty big-!”

“Reggie!” Junie snapped.

“And anyhow,” Jillian added, removing the photo and glaring at the youth with good humor, “she had them reduced. That’s this procedure code here.”

Nick sensed Jillian’s mounting tension as she opened the next record on the list. Her apprehension was understandable, he was thinking. Thanks to Reggie’s skill and the vulnerability of the electronic records system, they were committing an almost inexcusable invasion of privacy that would, quite possibly, cost Jillian and Nick their careers should they get caught. For the first time, he began to question his convictions.

Please, give us something. Anything.

Jillian merely sighed and began to scroll down the list. Nick did not recognize any of the names or most of the ICD codes as they flowed past. In his medical practice, he never dealt with lifts, reshaping, body contouring, liposuction, or breast work, so the unfamiliarity of the codes was understandable. Then, after a hundred or so patients, one ICD code caught his eye: 929.9. As a trauma surgeon, he knew that code well. Crushing injury of multiple sites.

“That one, Jill,” he said. “Please click on that one.”

The name of the patient was Giuseppe Renzulli. Nick remembered reading something on Paresh Singh’s Web site about his world-renowned reputation for tackling difficult reconstructive procedures, specifically shotgun wounds to the face. From what Nick read in the file and observed in the pre-op images, this particular case would have required a mastery beyond compare.

According to the physician notes in Renzulli’s record, the 929.9 was elaborated as a shotgun wound to the face. Most impressive were the stunning three-dimensional CT scans, each showing a sea of floating bone fragments and shotgun pellets, sandwiched between a cracked mandible and a remarkably intact frontal bone.

“Oh man, that’s gross!” Reggie exclaimed. “That dude dead?”

“According to this, he’s very much alive,” Nick answered.

He leaned over Jillian’s shoulder and read aloud from one of many physician dictations-the conclusion of the admission note by Paresh Singh.

The patient is a twenty-eight-year-old Caucasian male, with massive trauma to the neck and face from a self-inflicted shotgun wound. Definitive reconstruction and repair of nasal, orbital, maxillary, mandibular, and ethmoid fractures feasible, requiring multistaged reconstructive maneuvers. Primary access to fracture sites will be via transcutaneous vertical Lynch incision. 70% of fractures appear to be Type III.

Jillian turned away as he read. It was then Nick realized the man’s suicide attempt was another painful reminder of Belle. How could he be so insensitive? He placed a hand on her shoulder. She in turn reached across her body to take his hand in hers. The moment was brief, but the emotions within it were intense.

“How could somebody shoot themselves like that and not die?” Junie asked.

Nick flashed on one such case he had treated in Afghanistan, but before he said anything about it, he turned to Jillian.

“Talking about this okay?” he asked.

“Yeah, it’s okay,” she said, her tone bittersweet. “Thanks for asking.”

“A self-inflicted gunshot wound to the head is almost always fatal,” he explained, “that is, assuming the victim puts the gun in his or her mouth or presses it hard against the temple. But when a gun-a shotgun especially-is placed under the chin, the recoil can actually redirect the muzzle, causing massive trauma to the face, but avoiding any vital structures in the brain.”

“That’s gross,” Reggie said.

Nick took the mouse from Jillian and continued reviewing the file.

“For this guy, no doubt, fixing him was a massive undertaking. From these reports it looks as though he went through several multi-step reconstructive events, totaling about thirty operations.”

“That’s not the only total that was massive,” Jillian said. “Take a gander at the bill this case generated.”

Nick looked at where she was pointing and whistled.

“Half a million dollars for this work alone. No wonder Shelby Stone formed a partnership with these guys. Even if the patient defaults on their share of the bill, the insurance company owes a hefty six-figure payday for Singh, and a percentage of that goes to the mother hospital.”

“Well, that does explain how Paresh Singh can afford that marble fountain.”

“If they’re so well known for this type of work, I wonder how many shotgun injuries they reconstruct in a year?” Nick asked.

“I can tell you,” Jillian said. “I’ll just look it up by that ICD code.”

Jillian entered the numbers, keeping the scan limited to the twelve months beginning the approximate date Umberto disappeared.

“Keywords shotgun… and… face… and there you are.”

Four seconds after she hit the Enter key, twenty records were identified.

“Amazing,” Nick commented. “Maybe that’s what the J. Geils Band meant when they named their album Blow Your Face Out.”

“Who’s the J. Geils Band?” Reggie asked. “If I ain’t heard of them, they must be old.”

“With you, anything that wasn’t recorded last month is old.”

“Twenty cases in that one hospital doesn’t surprise me very much,” Jillian said. “Between fifty and fifty-five percent of all suicides are caused by guns, but there are over fifteen hundred attempted suicides in the U.S. alone each day.”

“That’s an incredible number,” Junie said.

“Sad, but true,” Jillian said.

Nick thought through the math.

“So, if Paresh Singh is world renowned for his ability to reconstruct faces after a shotgun blast,” he said, “it’s not inconceivable there could be at least a hundred such cases in the U.S. each year-probably more worldwide.”

“One-fifth of them sent to the best of the best makes sense to me.”

“Let’s look at these twenty,” Nick said, “but we’d better move quickly. Sooner or later someone’s going to catch on to the breach.”

Behind them, Reggie kept touching his face, as though trying to visualize how the gunshot wounds Nick described could actually be survivable.

The first five files they reviewed were grisly but also well documented. The skill of Paresh Singh was undeniable, although the residual facial damage in each case was still fairly striking. Nothing in those files jumped out at them as being out of the ordinary. Something troubled Nick about the sixth case, though, a patient named Edwin Scott Price from Plano, Texas.

The majority of suicide attempts with a firearm were males, thirty to fifty years old. Edwin Price was forty-five. But although he fit the profile, there was a feeling Nick could not shake while he was scanning the X-ray images, photos, and CT scans attached to Price’s file. Something about the record was familiar-not possible given that the electronic chart was one he’d never seen before, and the patient one he’d never heard of. The echoing concern nagged at him.

Why?

Nick was about to abandon the CT scans and move on when Reggie leaned over and exclaimed in his ear. “Dang! That dude is just as messed up as the first poor sucker we saw.”

“What do you mean?”

“I don’t know. I’m good at figuring out patterns, and those pieces of bone look almost exactly like that first guy you showed me.”

“That’s it!” Nick exclaimed.

“That’s what?” Jillian asked.

“Why I’ve been feeling like Price’s record was familiar. Let’s go back to that twenty-eight-year-old Caucasian male we looked at first.”

“Giuseppe Renzulli?”

“That’s the one.”

Jillian pulled up Renzulli’s file.

“Can we see both side by side?”

She opened a new window and soon had the two patients’ three-dimensional CT scans displayed next to each other.

“Well, I’ll be…” Junie’s voice trailed off.

“They’re identical,” Jillian said.

“Told you,” Reggie boasted.

Nick studied both pictures intently, his brow knit.

“I’m not a statistician,” he said. “But I’m willing to bet the RV that two identical bone fragment dispersals from a shotgun blast to the face is a statistical impossibility.”

“Are the procedures done on the men the same?” Junie asked.

“Doesn’t look like it to me,” Nick said. “Renzulli had some pretty significant complications that Paresh attributed to his anesthesia and local infection.”

“There’s something else we’re missing,” Jillian said. “I can feel it.”

Nick went back through Price’s and Renzulli’s notes and films. The only thing in common between the two records was the CT scan.

“Didn’t you just say that these procedures cost hundreds of thousands of dollars in hospital billing?” Junie asked.

Nick’s focus was locked on trolling through Price’s file, such that he almost missed the question.

“Yeah,” he said absently. “Why?”

“Well, take a look here,” Junie said, tapping her finger on the screen.

“Hey! Fingers off the monitor,” Reggie scolded.

“Well, I’ll be…” Nick had to blink to make sure he was reading it right. “Jillian, as a joint venture with Shelby Stone, doesn’t that mean Singh operates his medical practice himself, but combines his purchases and billing for supplies with Stone?” Nick asked.

“I think so. That way he gets the benefit of Stone’s purchase power. He probably sends Stone a percentage of his collections for the procedures he performs.”

“Well, according to this, Edwin Scott Price had almost a million dollars of reconstructive work done.”

“And? What am I missing?” Jillian asked.

She turned around in the chair to face both the others.

“What you’re missing and what Junie just pointed out,” Nick said, “is that none of Singh’s profits that were shared with Shelby Stone from Edwin Scott Price’s million-dollar new face came from an insurance company.”

“That would mean Singh didn’t want Price’s insurance company to even know he was doing the work. Why would that be?”

A devilish smile crossed Nick’s face.

“I don’t know. But let’s give our little implanted rootkit a rest and then when Reggie tells us it’s safe, we start looking to find other identical CT scans and take a real close look at Singh’s billing practices when it comes to fixing shotgun wounds.”