The Last Surgeon

CHAPTER 40

“You ready for this?” Nick asked as the screen lit up with static.

“Dunno,” Jillian said grimly. “Are you?”

“I’m not sure. We’ve come so far.”

“I can’t believe I’m going to see Belle alive.”

“Want me to stop it?” Nick asked, holding up the remote, given to him by Noreen.

“No, but I want to sit down, I think.”

Jillian inhaled deeply and took Nick’s hand in the darkness. They were six feet from the screen, about to watch a video that included the death of a patient. It also was probably going to include shots of Jillian’s younger sister, subsequently murdered in a manner that every policeman involved with the case believed was suicide.

Saul Mollender and Noreen Siliski sat next to each other, behind and to the right of the others. The tension in the room was high.

In half a minute, the static gave way to a set of standard legal notices, yellow on black, that included a summary of the HIPAA laws surrounding patient confidentiality, an outline of who was allowed to view the recording and for what purposes, and the name of the editor, Annette Furst, Department of Medical records. Finally came the hospital name, date, and operating room number. Jillian was rigid in her seat, squeezing blood from Nick’s hand.

The introductory information was in the same yellow print.

PATIENT: Aleem Syed Mohammad

Hospital ID: 881-83-7782-Karachi, Pakistan

Condition: Cardiac rhabdomyoma

Procedure: Cardiopulmonary bypass; excision of rhabdomyoma; cardiac reconstruction

Present in the Operating Room:

Surgeon: Abigail Spielmann, M.D.

Asst. Surgeon: Lewis Leonard, M.D.

Cardiac Surgical Resident: Yasmin Dasari-Olan, M.D.

Anesthesiologist: Thomas Landrew, M.D.

Perfusionist: Roger Pendleton, CCP, Cert. ABCP

Scrub Nurse: Kimberly Fox

Circulating Nurse: Cassandra Browning-Leavitt

Medical Student: Yu Jiang

Nursing Student: Belle Coates

Nick felt the energy in Jillian’s grip increase at the sight of her sister’s name. He froze the picture.

“Do we know who Dr. Abigail Spielmann is?” he asked.

“I think she was brought in from another hospital,” the Mole replied. “Probably an expert in cardiac tumors like this one.”

“She must be big stuff if the cardiac surgical chief would allow it,” Jillian said.

Nick undid the pause.

The printing gave way to a gleaming operating room. Three cameras, according to Mollender-one of them straight down into where the patient would be placed on the now empty table; one up from the foot; and the other giving a wide-angle shot of the entire operating room. The video editor’s job, Mollender explained, was to mix the various camera angles into a cohesive and useful presentation.

The opening sequence was shot from the wide-angle camera and showed the perfusionist, wearing scrubs, a mask, and hair cover, but set back from the sterile field where the surgeons would be working. Seated behind the long heart-lung bypass machine, he looked like a concert pianist preparing for a performance. He was chatting with the scrub nurse.

“Need anything?” the perfusionist said. “Cassandra’s right outside.”

The audio and visual feeds were excellent.

“As a matter of fact, yes,” the scrub nurse replied. “The only thing from Dr. Spielmann’s instrument list that I don’t have here is a Loc-Ness tissue stabilizer. Could you ask Cassandra to get one for me, please?”

“Will do. Have you met Spielmann?”

“She came by to see me a little while ago. She seems terrific.”

“I thought the same thing. Be right back.”

The scrub nurse was positioned just above and behind where Dr. Abigail Spielmann would be working. She was ready for the case-gloved, gowned, and masked, with intense dark eyes looking out from beneath her blue hair covering as she checked through a huge tray of instruments.

At that point there was some obvious editing-eleven minutes according to the running digital time in the upper right corner. The perfusionist was back at his post, and the circulating nurse had appeared and was helping one of the surgeons, a dark-skinned woman, it appeared, into her gloves and gown.

It felt stranger to Nick than he had expected to be viewing OR drama after so long. Between his internship, residency, fellowship in trauma surgery, private practice, and the military, he had been a surgeon for more than nine years before the explosion that took Sarah-nearly as long as he had been away from his specialty.

Suddenly, Jillian’s grasp on his hand intensified. Two people, a man and a woman, both in scrubs, mask, and hair covers, entered through the main doors and took a position against the wall, well away from the table.

“That’s her,” Jillian whispered loudly. “That’s Belle.”

Nick was able to make out a tallish, slender woman with very attractive eyes.

“If Dr. Spielmann has no objections,” the circulating nurse told Belle and the medical student, “we’ll get you up on risers so you can see more than people’s backs. Either way, the procedure will be on that screen. Have you both read up on cardiac rhabdomyomas?”

“Yes,” the students said in unison.

Nick felt Jillian stiff en at the sound of her sister’s voice.

“Great,” the circulator went on, “so you know it’s not a cancer that spreads to other parts of the body, but it arises from the inner heart muscle and just keeps growing and taking up space until cardiac function becomes severely compromised.”

There was another lengthy edit, leading to the sudden appearance at the head of the table of the anesthesiologist and, on the left side of the table, another surgeon-the first assistant, Nick assumed, actually remembering Lewis Leonard from the list of players because of a grade-school classmate in Oregon with the same name. At that moment, the main doors burst open and Aleem Syed Mohammad was wheeled in by two men in scrubs, surgical masks, and hair covers. In a short while, the infamous murderer and terrorist lying so peacefully on the stretcher was going to be dead.

Mohammad, eyes closed, probably in a pleasant swoon from his pre-op medication, had a sheet draped across his body from the midchest down. He was a swarthy, rather handsome man, with high cheekbones and narrow features, including a striking aquiline nose. Nick got a brief, clear view of him as he was transferred onto the operating table.

One of the two transport men remained in the room and was posted to Belle’s right, on the other side of the main doors. Nick recalled that such a person was not identified in the roster of those observing the procedure, and speculated that he was a security presence, probably from the CIA. He was a stocky man, of average height, and although only his eyes and throat were exposed, there was something strangely familiar about him.

The door to the scrub room opened and the principal medical player in the scene, Dr. Abigail Spielmann, backed into the room, her hands up in front of her, palms in. She was a surprisingly slight woman, with light blue eyes that sparkled with intelligence despite the distance from the camera. The hand drying and nurse-assisted gowning of the cardiac surgeon was edited out.

“Dr. Landrew,” she said to the anesthesiologist, every word tinged with authority, “anything I should know about in his pre-op examination?”

“His history and examination were done with the help of an interpreter. The patient had not received any medication that would alter his mental status, but he still seemed a little groggy.”

“Despite the grogginess, you trust his signing of the consent form?” Spielmann asked.

“I do. There were three witnesses-two nurses from his floor, and his interpreter.”

“I actually spoke with him after you did,” Spielmann said. “I have been using some tapes to learn a little Arabic. Mr. Mohammad seemed to know what I was saying, which made me very pleased. I was able to pick out a few words he said, but just a few. At the time we spoke, he seemed tired but in command of his faculties. So I agree with you, Dr. Landrew.”

“Excellent.”

“Then are we ready to get this show on the road?”

“Ready.”

“Mr. Pendleton?”

“Ready, Doctor,” said the perfusionist.

“Okay, then. We’ll put him to sleep and prep him as a team according to the method I have distributed to each of you. Those of you observing can take your places on the risers after he is asleep, prepped, and draped. Questions?”

There were none. The anesthesiologist adjusted his position to inject what Nick felt certain was succinylcholine to paralyze Mohammad before inserting a breathing tube into his trachea.

But at that instant, Aleem Syed Mohammad began to move.

First he stirred. Then he groaned. Then he reached both hands up and squeezed them against the sides of his head. Next he began to moan, then he cried out loudly and suddenly he screamed.

A moment later, he sat bolt upright, flailing his arms and screeching at the top of his lungs in what Nick assumed was Arabic. Instantly, everyone around the operating table seemed to be speaking and moving at once. The surgeons and the circulating nurse tried to force him back onto the table. His flailing arms caught one of the assistants on the side of the face and sent her sprawling. His IV tore from his arm. Blood instantly began oozing through the gauze that had been holding the large cannula in place.

His cries of pain grew louder still. His eyes seemed twice their natural size.

He violently snapped his head from side to side as if trying to dislodge a parasite.

Then, with his arms waving wildly, he flung himself off the table, sending the circulating nurse and a surgical assistant crashing into the heart-lung perfusion pump, which rose up on two wheels and toppled over.

The camera angle switched to the one looking from the foot of the OR bed toward the head-the only view that could show the utter chaos on the operating room floor, where three people struggled amidst the fluids from the IVs and the perfusion machine.

“Sa’edoony, sa’edoony!” Mohammad shouted out.

“I’m sure that’s Arabic,” Nick said. “But I don’t know what it means.”

Despite the noise and commotion, Mohammad’s words were clear.

“Sa’edoony… ahderoo lee ed-Doctor Fury… ahderoo lee ed-Doctor Nick Fury! Sa’edoony… ¡Socorro! ¡Ayúdenme! ¡Búsquenme al Doctor Nick Fury!”

“Oh my God!” Nick exclaimed in a strained whisper. “That last bit wasn’t Arabic, it was Spanish. It’s Umberto! That’s his voice. I swear it is! He’s calling for me!”

“Sa’edoony!…”

Umberto’s screams echoed through the room.

The camera angle was switched to the overhead view.

Then, as suddenly as it had started, the thrashing and screaming ended. The surgical assistants stumbled to their feet and lifted the lifeless body of their patient back onto the table.

Nick felt ill as the man’s head flopped back. His face was absolutely that of Aleem Syed Mohammad.

Plastic surgery! Nick realized. Lots of it.

“Pump!” Abigail Spielmann ordered.

“Endotracheal tube is in.”

“No pulse,” someone called out.

“Both lungs aerating.”

“EKG is hooked up. Flat line. Absolutely flat.”

“Pupils are blown, fully dilated, and fixed on both sides.”

“Keep pumping.”

“BP zero.”

“Looks as if he blew an aneurysm in his head,” Abigail Spielmann said with seasoned calm. “A huge one, I suspect. Could I have two ccs of epi on an intracardiac needle. I think we should see what this does and then make a decision about opening his chest for manual compressions.”

“BP still zero.”

Spielmann took the long cardiac needle and drove it down beside the patient’s sternum, keeping suction on the plunger. There was an immediate jet of dark, almost black blood into the syringe. She injected the contents into the left ventricle of the heart.

“Nothing. Straight line.”

“BP zero.”

“Pupils fixed.”

“I cannot see anything to be gained by going to the final level and opening this man’s chest. Anyone feel differently?” There was only silence from the room. “Okay, then. Time of death ten thirty-one A.M. Thank you, everybody. I appreciate your efforts. I’m very sorry this happened.”

The overhead camera showed the deceased man’s face, staring sightlessly upward at the saucer lights. Nick hit Pause and held the image in the center of the screen.

“My God,” Nick said. “While they were doing all that work on Umberto’s face, they must have taught him Arabic so he would be ready for the pre-op interviews.”

“It’s just like when I heard Manny speak in Arabic. Billy Pearl said that Manny had been brainwashed. I bet the same thing was done to Umberto,” Jillian said.

“Did your sister speak Arabic?” Mollender asked.

“No. But as Nick said, the Arabic Umberto spoke was mixed in with Spanish.”

“Okay. So, did your sister speak Spanish?”

“She was almost fluent,” Jillian replied. “We both were.”