The Surgeon

Eight

Catherine jerked rigid in bed, heart slamming in her chest, every nerve electric with fear. She stared at the darkness, struggling to quell her panic.

Someone was pounding on the door of the call room. “Dr. Cordell?” Catherine recognized the voice of one of the E.R. nurses. “Dr. Cordell!”

“Yes?” said Catherine.

“We have a trauma case coming in! Massive blood loss, abdominal and neck wounds. I know Dr. Ames is covering for trauma tonight, but he’s delayed. Dr. Kimball could use your help!”

“Tell him I’ll be there.” Catherine turned on the lamp and stared at the clock. It was 2:45 A.M. She’d slept only three hours. The green silk dress was still draped over the chair. It looked like something foreign, from another woman’s life, not her own.

The scrub suit she’d worn to bed was damp with sweat, but she had no time to change. She gathered her tangled hair in a ponytail and went to the sink to splash cold water on her face. The woman staring back at her from the mirror was a shell-shocked stranger. Focus. It’s time to let go of the fear. Time to go to work. She slipped her bare feet into the running shoes she’d retrieved from her hospital locker and, with a deep breath, stepped out of the call room.

“ETA two minutes!” called the E.R. clerk. “Ambulance says pressure’s down to seventy systolic!”

“Dr. Cordell, they’re setting up in Trauma One.”

“Who’ve we got on the team?”

“Dr. Kimball and two interns. Thank god you’re already in-house. Dr. Ames’s car conked out and he can’t get in….”

Catherine pushed into Trauma One. In a glance she saw the team had prepared for the worst. Three poles were hung with Ringer’s lacate; IV tubes were coiled and ready for connection. A courier was standing by to run blood tubes to the lab. The two interns stood on either side of the table, clutching IV catheters, and Ken Kimball, the E.R. doc on duty, had already broken the tape sealing the laparotomy tray.

Catherine pulled on a surgical cap, then thrust her arms into the sleeves of a sterile gown. A nurse tied the gown in back and held open the first glove. With every piece of the uniform came another layer of authority and she was feeling stronger, more in control. In this room, she was the savior, not the victim.

“What’s the story on the patient?” she asked Kimball.

“Assault. Trauma to the neck and abdomen.”

“Gunshot?”

“No. Stab wounds.”

Catherine paused in the act of snapping on the second glove. A knot had suddenly formed in her stomach. Neck and abdomen. Stab wounds.

“Ambulance is pulling in!” a nurse yelled through the doorway.

“Blood and guts time,” said Kimball, and he stepped out to meet the patient.

Catherine, already in sterile garb, stayed right where she was. The room had suddenly gone silent. Neither the two interns flanking the table nor the scrub nurse, poised to hand Catherine surgical instruments, said a word. They were focused on what was happening beyond the door.

They heard Kimball yell: “Go, go, go!”

The door flew open, and the gurney wheeled in. Catherine caught a glimpse of blood-soaked sheets, of a woman’s matted brown hair and a face obscured by the tape holding an ET tube in place.

With a one-two-three! they slid the patient onto the table.

Kimball pulled off the sheet, baring the victim’s torso.

In the chaos of that room, no one heard Catherine’s sharp intake of breath. No one noticed her take a stumbling step backward. She stared at the victim’s neck, where the pressure dressing was saturated a deep red. She looked at the abdo- men, where another hastily applied dressing was already peeling free, spilling trickles of blood down the naked flank. Even as everyone else sprang into action, connecting IV’s and cardiac leads, squeezing air into the victim’s lungs, Catherine stood immobilized by horror.

Kimball peeled off the abdominal dressing. Loops of small bowel spilled out and plopped onto the table.

“Systolic’s barely palpable at sixty! She’s in sinus tach—”

“I can’t get this IV in! Her vein’s collapsed!”

“Go for a subclavian!”

“Can you toss me another catheter?”

“Shit, this whole field’s contaminated….”

“Dr. Cordell? Dr. Cordell?”

Still in a daze, Catherine turned to the nurse who’d just spoken and saw the woman frowning at her over the surgical mask.

“Do you want lap pads?”

Catherine swallowed. Took a deep breath. “Yes. Lap pads. And suction…” She re-focused on the patient. A young woman. She had a disorienting flashback to another E.R., to the night in Savannah when she herself had been the woman lying on the table.

I won’t let you die. I won’t let him claim you.

She grabbed a handful of sponges and a hemostat from the instrument tray. She was fully focused now, the professional back in control. All the years of surgical training automatically kicked into gear. She turned her attention first to the neck wound and peeled off the pressure dressing. Dark blood dribbled out and splattered the floor.

“The carotid!” said one of the interns.

Catherine slapped a sponge against the wound and took a deep breath. “No. No, if it was the carotid she’d already be dead.” She looked at the scrub nurse. “Scalpel.”

The instrument was slapped in her hand. She paused, steadying herself for the delicate task, and placed the tip of the scalpel on the neck. Maintaining pressure on the wound, Catherine swiftly slit through the skin and dissected upward toward the jaw, exposing the jugular vein. “He didn’t cut deep enough to reach the carotid,” she said. “But he did get the jugular. And this end’s retracted up into the soft tissue.” She tossed down the scalpel and grabbed the thumb forceps. “Intern? I need you to sponge. Gently! ”

“You going to re-anastomose?”

“No, we’re just going to tie it off. She’ll develop collateral drainage. I need to expose enough vein to get suture around it. Vascular clamp.”

Instantly the instrument was in her hand.

Catherine positioned the clamp and snapped it over the exposed vessel. Then she released a sigh and glanced at Kimball. “This bleeder’s down. I’ll tie it off later.”

She turned her attention to the abdomen. By now Kimball and the other intern had cleared the field using suction and lap pads, and the wound was fully exposed. Gently Catherine nudged aside loops of bowel and stared into the open incision. What she saw made her sick with rage.

She met Kimball’s stunned gaze across the table.

“Who would do this?” he said softly. “Who the hell are we dealing with?”

“A monster,” she said.

“The vic’s still in surgery. She’s still alive.” Rizzoli snapped her cell phone shut and looked at Moore and Dr. Zucker. “We now have a witness. Our unsub’s getting careless.”

“Not careless,” said Moore. “Rushed. He didn’t have time to finish the job.” Moore stood by the bedroom door, studying the blood on the floor. It was still fresh, still glistening. It’s had no time to dry. The Surgeon was just here.

“The photo was e-mailed to Cordell at seven fifty-five P.M.,” said Rizzoli. “The clock in the photo said two-twenty.” She pointed to the clock on the nightstand. “That’s set at the correct time. Which means he must have taken the photo last night. He kept that victim alive, in this house, for over twenty-four hours.”

Prolonging the pleasure.

“He’s getting cocky,” said Dr. Zucker, and there was an unsettling note of admiration in his voice. An acknowledgment that here was a worthy opponent. “Not only does he keep the victim alive for a whole day; he actually leaves her here, for a time, to send that e-mail. Our boy is playing mind games with us.”

“Or with Catherine Cordell,” said Moore.

The victim’s purse was lying on top of the dresser. With gloved hands, Moore went through the contents. “Wallet with thirty-four dollars. Two credit cards. Triple A card. Employee ID badge for Lawrence Scientific Supplies, Sales Department. Driver’s license, Nina Peyton, twenty-nine years old, five foot four, a hundred thirty pounds.” He flipped over the license. “Organ donor.”

“I think she just donated,” said Rizzoli.

He unzipped a side pocket. “There’s a datebook.”

Rizzoli turned to look at him with interest. “Yes?”

He opened the book to the current month. It was blank. He flipped backward until he found an entry, written nearly eight weeks before: Rent due. He flipped further back and saw more entries: Sid’s B-day. Dry cleaning. Concert 8:00. Staff meeting. All the mundane little details that make up a life. Why had the entries suddenly stopped eight weeks ago? He thought of the woman who had written these words, printing neatly in blue ink. A woman who had probably looked ahead to the blank page for December and pictured Christmas and snow with every reason to believe she would be alive to see it.

He closed the book and was so overwhelmed by sadness that for a moment he could not speak.

“There’s nothing at all left behind in the sheets,” said Frost, crouched by the bed. “No loose surgical threads, no instruments, nothing.”

“For a guy who was supposedly in a hurry to leave,” said Rizzoli, “he did a good job of cleaning up after himself. And look. He had time to fold the nightclothes.” She pointed to a cotton nightgown, which lay neatly folded on a chair. “This doesn’t go along with his being in a rush.”

“But he left his victim alive,” said Moore. “The worst possible mistake.”

“It doesn’t make sense, Moore. He folds the nightgown, picks up after himself. And then he’s so careless as to leave behind a witness? He’s too smart to make this mistake.”

“Even the smartest ones screw up,” said Zucker. “Ted Bundy got careless at the end.”

Moore looked at Frost. “You’re the one who called the victim?”

“Yeah. When we were running down that list of phone numbers the library gave us. I called this residence around two, two-fifteen. I got the answering machine. I didn’t leave any message.”

Moore glanced around the room but saw no answering machine. He walked out to the living room and spotted the phone on the end table. It had a caller ID box, and the memory button was smeared with blood.

He used the tip of a pencil to press the button, and the phone number of the last caller was displayed on the digital readout.

Boston PD 2:14 A.M.

“Is that what spooked him?” asked Zucker, who’d followed him into the living room.

“He was right here when Frost called. There’s blood on the caller ID button.”

“So the phone rang. And our unsub wasn’t finished. He hadn’t achieved satisfaction. But a phone call in the middle of the night must have rattled him. He came out here, into the living room, and saw the number on the caller ID box. Saw it was the police, trying to reach the victim.” Zucker paused. “What would you do?”

“I’d clear out of here.”

Zucker nodded, and a smile twitched at his lips.

This is all a game to you, thought Moore. He went to the window and looked out at the street, which was now a bright kaleidoscope of flashing blue lights. Half a dozen cruisers were parked in front of the house. The press was out there, too; he could see the local TV vans setting up their satellite feeds.

“He didn’t get to enjoy it,” Zucker said.

“He completed the excision.”

“No, that’s just the souvenir. A little reminder of his visit. He wasn’t here just to collect a body part. He came for the ultimate thrill: to feel a woman’s life drain away. But this time he didn’t achieve it. He was interrupted, distracted by fear that the police were coming. He didn’t stay long enough to watch his victim die.” Zucker paused. “The next one’s going to come very soon. Our unsub is frustrated, and the tension is getting unbearable for him. Which means he’s already on the hunt for a new victim.”

“Or he’s already chosen her,” said Moore. And thought: Catherine Cordell.

The first streaks of dawn were lightening the sky. Moore had not slept in nearly twenty-four hours, had been going full throttle for most of the night, fueled only by coffee. Yet as he looked up at the brightening sky, what he felt was not exhaustion but renewed agitation. There was some connection between Catherine and the Surgeon that he did not understand. Some invisible thread that bound her to that monster.

“Moore.”

He turned to see Rizzoli and instantly picked up on the excitement in her eyes.

“Sex Crimes just called,” she said. “Our victim is a very unlucky lady.”

“What do you mean?”

“Two months ago, Nina Peyton was sexually assaulted.”

The news stunned Moore. He thought of the blank pages in the victim’s datebook. Eight weeks ago, the entries had stopped. That was when Nina Peyton’s life had screeched to a halt.

“There’s a report on file?” said Zucker.

“Not just a report,” said Rizzoli. “A rape kit was collected.”

“Two rape victims?” said Zucker. “Could it be this easy?”

“You think their rapist comes back to kill them?”

“It’s got to be more than random chance. Ten percent of serial rapists later communicate with their victims. It’s the perp’s way of prolonging the torment. The obsession.”

“Rape as foreplay to murder.” Rizzoli gave a disgusted snort. “Nice.”

A new thought suddenly occurred to Moore. “You said a rape kit was collected. So there was a vaginal swab?”

“Yep. DNA’s pending.”

“Who collected that swab? Did she go to the emergency room?” He was almost certain that she’d say: Pilgrim Hospital.

But Rizzoli shook her head. “Not the E.R. She went to Forest Hills Women’s Clinic. It’s right down the road.”

On a wall in the clinic waiting room, a full-color poster of the female genital tract was displayed beneath the words: Woman. Amazing Beauty. Though Moore agreed that a woman’s body was a miraculous creation, he felt like a dirty voyeur, staring at that explicit diagram. He noticed that several women in the waiting room were eyeing him the way gazelles regard a predator in their midst. That he was accompanied by Rizzoli did not seem to alter the fact he was the alien male.

He was relieved when the receptionist finally said, “She’ll see you now, Detectives. It’s the last room on the right.”

Rizzoli led the way down the hall, past posters with The 10 signs your partner is abusive and How do you know if it’s rape? With every step he felt as if another stain of male guilt had attached itself to him, like dirt soiling his clothes. Rizzoli felt none of this; she was the one on familiar ground. The territory of women. She knocked on the door that said: “Sarah Daly, Nurse Practitioner.”

“Come in.”

The woman who stood up to greet them was young and hip-looking. Under her white coat she wore blue jeans and a black tee shirt, and her boyish haircut emphasized dark gamine eyes and elegant cheekbones. But what Moore could not stop focusing on was the small gold hoop in her left nostril. For much of the interview, he felt as if he were talking to that hoop.

“I reviewed her medical chart after you called,” said Sarah. “I know a police report was filed.”

“We’ve read it,” said Rizzoli.

“And your reason for coming here?”

“Nina Peyton was attacked last night, in her home. She’s now in critical condition.”

The woman’s first reaction was shock. And then, fast on its heels, rage. Moore saw it in the way her chin jutted up and her eyes glittered. “Was it him?”

“Him?”

“The man who raped her?”

“It’s a possibility we’re considering,” said Rizzoli. “Unfortunately, the victim is comatose and can’t talk to us.”

“Don’t call her the victim. She does have a name.”

Rizzoli’s chin jutted up as well, and Moore knew she was pissed off. It was not a good way to start an interview.

He said, “Ms. Daly, this was an incredibly brutal crime, and we need—”

“Nothing is incredible,” retorted Sarah. “Not when we’re talking about what men do to women.” She picked up a folder from her desk and held it out to him. “Her medical record. The morning after she was raped, she came to this clinic. I was the one who saw her that day.”

“Were you also the one who examined her?”

“I did everything. The interview, the pelvic exam. I took the vaginal swabs and confirmed there was sperm under the microscope. I combed the pubic hair, collected nail clippings for the rape kit. Gave her the morning-after pill.”

“She didn’t go to the E.R. for any other tests?”

“A rape victim who walks in our door gets everything taken care of in this building, by one person. The last thing she needs is a parade of changing faces. So I draw the blood and send it out to the lab. I make the necessary calls to the police. If that’s what the victim wants.”

Moore opened the folder and saw the patient information sheet. Nina Peyton’s date of birth, address, phone number, and employer were listed. He flipped to the next page and saw it was filled with small, tight handwriting. The date of the first entry was May 17.

Chief Complaint: Sexual assault

History of Present Illness: 29-year-old white female, believes she was sexually assaulted. Last night while having drinks at the Gramercy Pub, she felt dizzy and remembers walking to the bathroom. She has no memory of any events that followed….

“She woke up at home, in her own bed,” said Sarah. “She didn’t remember how she got home. Didn’t remember getting undressed. She certainly didn’t remember tearing her own blouse. But there she was, stripped of her clothes. Her thighs were caked with what she thought was semen. One eye was swollen, and she had bruises on both wrists. She figured out pretty quick what had happened. And she had the same reaction other rape victims have. She thought: ‘It’s my fault. I shouldn’t have been so careless.’ But that’s how it is with women.” She looked directly at Moore. “We blame ourselves for everything, even when it’s the man who does the fucking.”

In the face of such anger, there was nothing he could say. He looked down at the chart and read the physical exam.

Patient is a disheveled, withdrawn female who speaks in a monotone. She is unaccompanied, and has walked to the clinic from her home….

“She kept talking about her car keys,” said Sarah. “She was battered, one eye was swollen shut, and all she could focus on was the fact she’d lost her car keys and she needed to find them or she couldn’t drive to work. It took me awhile to get her to break out of that repeating loop and talk to me. This is a woman who’d never had anything really bad happen to her. She was educated, independent. A sales rep for Lawrence Scientific Supplies. She deals with people every day. And here she was, practically paralyzed. Obsessed with finding her stupid car keys. Finally we opened her purse and searched through all the pockets, and the keys were there. Only after we found them could she focus on me, and tell me what happened.”

“And what did she say?”

“She went into the Gramercy Pub around nine o’clock to meet a girlfriend. The friend never showed, so Nina hung around for a while. Had a martini, talked to a few guys. Look, I’ve been there, and every night it’s a busy place. A woman would feel safe.” She added, on a bitter note: “As if there is any safe place.”

“Did she remember the man who took her home?” asked Rizzoli. “That’s what we really need to know.”

Sarah looked at her. “It’s all about the criminal, isn’t it? That’s all those two cops from Sex Crimes wanted to hear about. The perp gets the attention.”

Moore could feel the room heating up with Rizzoli’s temper. He said, quickly: “The detectives said she was unable to provide a description.”

“I was in the room when they interviewed her. She asked me to stay, so I heard the whole story twice. They kept after her about what he looked like, and she just couldn’t tell them. She honestly could not remember anything about him.”

Moore turned to the next page in the chart. “You saw her a second time, in July. Only a week ago.”

“She came back for a follow-up blood test. It takes six weeks after exposure for an HIV test to become positive. That’s the ultimate atrocity. First to be raped, and then to find out your attacker has given you a fatal disease. It’s six weeks of agony for these women, waiting to find out if they’ll get AIDS. Wondering if the enemy is inside you, multiplying in your blood. When they come for their follow-up test, I have to give them a pep talk. And swear that I’ll call them the instant I get the results back.”

“You don’t analyze the tests here?”

“No. It all gets sent out to Interpath Labs.”

Moore turned to the last page of the chart and saw the sheet of results. HIV screen: Negative. VDRL (syphilis): Negative. The page was tissue-thin, a sheet from a printed carbon form. The most important news of our lives, he thought, so often arrives on such flimsy paper. Telegrams. Exam scores. Blood tests.

He closed the chart and laid it on the desk. “When you saw Nina the second time, the day she came in for the follow-up blood test, how did she strike you?”

“Are you asking me if she was still traumatized?”

“I have no doubt she was.”

His quiet answer seemed to puncture Sarah’s swelling bubble of rage. She sat back, as though, without anger, she had lost some vital fuel. For a moment she considered his question. “When I saw Nina the second time, she was like one of the walking dead.”

“How so?”

“She sat in that chair where Detective Rizzoli is now, and I felt as if I could almost see straight through her. As if she was transparent. She hadn’t been to work since the rape. I think it was hard for her to face people, especially men. She was paralyzed by all these strange phobias. Afraid to drink tap water, or anything that hadn’t been sealed. It had to be in an unopened bottle or can, something that couldn’t be poisoned or drugged. She was afraid that men could look at her and see she’d been violated. She was convinced her rapist had left sperm on her bedsheets and clothes, and she was spending hours every day washing things over and over. Whoever Nina Peyton used to be, that woman was dead. What I saw in her place was a ghost.” Sarah’s voice had trailed off, and she sat very still, staring toward Rizzoli, seeing another woman in that chair. A succession of women, different faces, different ghosts, a parade of the damaged.

“Did she say anything about being stalked? About the attacker reappearing in her life?”

“A rapist never disappears from your life. For as long as you live, you’re always his property.” Sarah paused. And added, bitterly: “Maybe he just came to claim what was his.”