The Surgeon

Eleven

Nina Peyton’s eyes were wide and frantic. Four-point restraints held her wrists and ankles to the bedrails, and the tendons of her arms stood out in thick cords as she fought to free her hands.

“She regained consciousness about five minutes ago,” said Stephanie, the SICU nurse. “First I noticed her heart rate was up, and then I saw her eyes were open. I’ve been trying to calm her down, but she keeps fighting the restraints.”

Catherine looked at the cardiac monitor and saw a rapid heart rate but no arrhythmias. Nina’s breathing was rapid as well, occasionally punctuated by explosive wheezes that expelled blasts of phlegm out the endotracheal tube.

“It’s the ET tube,” said Catherine. “It’s making her panic.”

“Shall I give her some Valium?”

Moore said, from the doorway, “We need her conscious. If she’s sedated, we can’t get any answers.”

“She can’t talk to you anyway. Not with the ET tube in.” Catherine looked at Stephanie. “How were the last blood gases? Can we extubate?”

Stephanie flipped through her papers on the clipboard. “They’re borderline. P02’s sixty-five. PC02 thirty-two. That’s on the T-tube at forty percent oxygen.”

Catherine frowned, liking none of the options. She wanted Nina awake and able to talk just as much as the police did, but she was juggling several concerns at once. The sensation of a tube lodged in the throat can induce panic in anyone, and Nina was so agitated that her restrained wrists were already chafed raw. But removing the tube carried risks as well. Fluid had accumulated in her lungs after surgery, and even while she was breathing 40 percent oxygen — twice that of room air — her blood oxygen saturation was barely adequate. That’s why Catherine had left the tube in place. If they removed the tube, they would lose a margin of safety. If they left it in, the patient would continue to panic and thrash. If they sedated her, Moore’s questions would go unanswered.

Catherine looked at Stephanie. “I’m going to extubate.”

“Are you sure?”

“If there’s any deterioration I’ll re-intubate.” Easier said than done was what she saw in Stephanie’s eyes. After several days with a tube in place, the laryngeal tissues sometimes swelled, making re-intubation difficult. An emergency tracheotomy would be the only option.

Catherine circled around behind her patient’s head and gently cupped her face. “Nina, I’m Dr. Cordell. I’m going to take the tube out. Is that what you want?”

The patient nodded, a response that was sharp and desperate.

“I need you to be very still, okay? So we don’t injure your vocal cords.” Catherine glanced up. “Mask ready?”

Stephanie held up the plastic oxygen mask.

Catherine gave Nina’s shoulder a reassuring squeeze. She peeled off the tape holding the tube in place and released air from the balloonlike inflator cuff. “Take a deep breath and exhale,” said Catherine. She watched the chest expand, and as Nina released the breath, Catherine eased out the tube.

It emerged in a spray of mucus as Nina coughed and wheezed. Catherine stroked her hair, murmuring gently as Stephanie fastened an oxygen mask in place.

“You’re doing fine,” said Catherine.

But the blips on the cardiac monitor continued to race by. Nina’s frightened gaze remained focused on Catherine, as though she was her lifeline and she dared not lose sight of her. Looking into her patient’s eyes, Catherine felt a disturbing flash of familiarity. This was me two years ago. Waking up in a Savannah hospital. Surfacing from one nightmare, into another…

She looked at the straps holding Nina’s wrists and ankles and remembered how terrifying it was to be tied down. The way she’d been tied down by Andrew Capra.

“Take off the restraints,” she said.

“But she might pull out her lines.”

“Just take them off.”

Stephanie flushed at the rebuke. Without a word she untied the straps. She did not understand; no one could understand but Catherine, who, even two years after Savannah, could not abide sleeves with tight cuffs. As the last restraint fell free, she saw Nina’s lips move in a silent message.

Thank you.

Gradually the beep of the EKG slowed. Against the steady rhythm of that heartbeat, the two women gazed at each other. If Catherine had recognized a part of herself in Nina’s eyes, so, too, did Nina seem to recognize herself in Catherine’s. The silent sisterhood of victims.

There are more of us than anyone will ever know.

“You can come in now, Detectives,” the nurse said.

Moore and Frost stepped into the cubicle and found Catherine seated at the bedside, holding Nina’s hand.

“She asked me to stay,” said Catherine.

“I can call in a female officer,” said Moore.

“No, she wants me,” said Catherine. “I’m not leaving.”

She looked straight at Moore, her gaze unyielding, and he realized this was not the same woman he had held in his arms only a few hours ago; this was a different side of her, fierce and protective, and on this matter she would not back down.

He nodded and sat down at the bedside. Frost set up the cassette recorder and took an unobtrusive position at the foot of the bed. It was Frost’s blandness, his quiet civility, that made Moore choose him to sit in on this interview. The last thing Nina Peyton needed to face was an over-aggressive cop.

Her oxygen mask had been removed and replaced with nasal prongs, and air hissed from the tube into her nostrils. Her gaze darted between the two men, eyes alert to any threats, any sudden gestures. Moore was careful to keep his voice soft as he introduced himself and Barry Frost. He guided her through the preliminaries, confirming her name and age and address. This information they already knew, but by asking her to state it on tape they established her mental status and demonstrated she was alert and competent to make a statement. She answered his questions in a hoarse, flat voice, eerily devoid of emotion. Her remoteness unnverved him; he felt as though he were listening to a dead woman.

“I didn’t hear him come into my house,” she said. “I didn’t wake up until he was standing over my bed. I shouldn’t have left the windows open. I shouldn’t have taken the pills….”

“What pills?” Moore asked gently.

“I was having trouble sleeping, because of…” Her voice faded.

“The rape?”

She looked away, avoiding his gaze. “I was having nightmares. At the clinic, they gave me pills. To help me sleep.”

And a nightmare, a real nightmare, walked right into her bedroom.

“Did you see his face?” he asked.

“It was dark. I could hear him breathing, but I couldn’t move. I couldn’t scream.”

“You were already tied down?”

“I don’t remember him doing it. I don’t remember how it happened.”

Chloroform, thought Moore, to subdue her first. Before she was fully awake.

“What happened then, Nina?”

Her breathing accelerated. On the monitor above her bed, the heart tracing blipped faster.

“He sat in a chair by my bed. I could see his shadow.”

“And what did he do?”

“He — he talked to me.”

“What did he say?”

“He said…” She swallowed. “He said that I was dirty. Contaminated. He said I should be disgusted by my own filth. And that he — he was going to cut out the part that was tainted and make me pure again.” She paused. And said, in a whisper: “That’s when I knew I was going to die.”

Though Catherine’s face had turned white, the victim herself looked eerily composed, as though she were talking about another woman’s nightmare, not her own. She was no longer looking at Moore but staring at some point beyond him, seeing from afar a woman tied to a bed. And in a chair, hidden in the darkness, a man quietly describing the horrors he planned next. For the Surgeon, thought Moore, this is foreplay. This is what excites him. The smell of a woman’s fear. He feeds on it. He sits by her bed and fills her mind with images of death. Sweat blooms on her skin, sweat that exudes the sour scent of terror. An exotic perfume he craves. He breathes it in, and he is excited.

“What happened next?” said Moore.

No answer.

“Nina?”

“He turned the lamp on my face. He put it right in my eyes, so I couldn’t see him. All I could see was that bright light. And he took my picture.”

“And then?”

She looked at him. “Then he was gone.”

“He left you alone in the house?”

“Not alone. I could hear him, walking around. And the TV — all night, I heard the TV.”

The pattern has changed, thought Moore, and he and Frost exchanged stunned looks. The Surgeon was now more confident. More daring. Instead of completing his kill within a few hours, he had delayed. All night, and the next day, he had left his prey tied to her bed, to contemplate her coming ordeal. Heedless of the risks, he had drawn out her terror. Drawn out his pleasure.

The heartbeats on the monitor had sped up again. Though her voice sounded flat and lifeless, beneath the calm facade the fear remained.

“What happened then, Nina?” he asked.

“Sometime in the afternoon, I must have fallen asleep. When I woke up, it was dark again. I was so thirsty. It was all I could think about, how much I wanted water….”

“Did he leave you at any time? Were you ever alone in the house?”

“I don’t know. All I could hear was the TV. When he turned it off, I knew. I knew he was coming back into my room.”

“And when he did, did he turn on the light?”

“Yes.”

“Did you see his face?”

“Just his eyes. He was wearing a mask. The kind that doctors wear.”

“But you did see his eyes.”

“Yes.”

“Did you recognize him? Had you ever seen this man before in your life?”

There was a long silence. Moore felt his own heart pounding as he waited for the answer he hoped for.

Then she said, softly: “No.”

He sank back in his chair. The tension in the room had suddenly collapsed. To this victim, the Surgeon was a stranger, a man without a name, whose reasons for choosing her remained a mystery.

Masking the disappointment in his voice, he said: “Describe him for us, Nina.”

She took a deep breath and closed her eyes, as though to conjure up the memory. “He had… he had short hair. Cut very neatly…”

“What color?”

“Brown. A light shade of brown.”

Consistent with the strand of hair they’d found in Elena Ortiz’s wound. “So he was Caucasian?” said Moore.

“Yes.”

“Eyes?”

“A pale color. Blue or gray. I was afraid to look straight at them.”

“And the shape of his face? Round, oval?”

“Narrow.” She paused. “Ordinary.”

“Height and weight?”

“It’s hard to—”

“Your best guess.”

She sighed. “Average.”

Average. Ordinary. A monster who looked like any other man.

Moore turned to Frost. “Let’s show her the six-packs.”

Frost handed him the first book of mug shots, called six-packs because there were six photographs per page. Moore set the book on a bedside tray table and wheeled it in front of the patient.

For the next half hour they watched with sinking hopes as she flipped through the books without pausing. No one spoke; there was only the hiss of the oxygen and the sound of the pages being turned. These photos were of known sex offenders, and as Nina turned page after page it seemed to Moore that there was no end to the faces, that this parade of images represented the dark side of every man, the reptilian impulse disguised by a human mask.

He heard a tap on the cubicle window. Looking up, he saw Jane Rizzoli gesturing to him.

He stepped out to speak to her.

“Any ID yet?” she asked.

“We’re not going to get one. He was wearing a surgeon’s mask.”

Rizzoli frowned. “Why a mask?”

“It could be part of his ritual. Part of what turns him on. Playing doctor is his fantasy. He told her he was going to cut out the organ that had been defiled. He knew she was a rape victim. And what did he cut out? He went right for the womb.”

Rizzoli gazed into the cubicle. She said quietly: “I can think of another reason why he wore that mask.”

“Why?”

“He didn’t want her to see his face. He didn’t want her to identify him.”

“But that would mean…”

“It’s what I’ve been saying all along.” Rizzoli turned and looked at Moore. “The Surgeon fully intended for Nina Peyton to survive.”

How little we truly see into the human heart, thought Catherine as she studied the X ray of Nina Peyton’s chest. Standing in semidarkness, she gazed at the film clipped to the light box, studying the shadows cast by bones and organs. The rib cage, the trampoline of diaphragm, and resting atop it the heart. Not the seat of the soul, but merely a muscular pump, unendowed with any more mystical purpose than the lungs or the kidneys. Yet even Catherine, so grounded in science, could not look at Nina Peyton’s heart without being moved by its symbolism.

It was the heart of a survivor.

She heard voices in the next room. It was Peter, requesting a patient’s films from the file clerk. A moment later he walked into the reading room and paused when he saw her, standing by the light box.

“You’re still here?” he said.

“So are you.”

“But I’m the one on call tonight. Why don’t you go home?”

Catherine turned back to Nina’s chest X ray. “I want to be sure this patient is stable first.”

He came to stand right beside her, so tall, so imposing, that she had to fight the impulse to step away. He scanned the film.

“Other than some atelectasis, I don’t see much there to worry about.” He focused on the name “Jane Doe” in the corner of the film. “Is this the woman in Bed Twelve? The one with all the cops hanging around?”

“Yes.”

“I see you extubated her.”

“A few hours ago,” she said reluctantly. She had no wish to talk about Nina Peyton, no wish to reveal her personal involvement in the case. But Peter kept asking questions.

“Her blood gases okay?”

“They’re adequate.”

“And she’s otherwise stable?”

“Yes.”

“Then why don’t you go home? I’ll cover for you.”

“I’d like to keep an eye on this patient myself.”

He placed his hand on her shoulder. “Since when did you stop trusting your own partner?”

At once she froze at his touch. He felt it and withdrew his hand.

After a silence, Peter moved away and began hanging his X rays on the box, shoving them briskly into place. He’d brought in an abdominal CT series, and the films took up an entire row of clips. When he had finished hanging them, he stood very still, his eyes hidden by the X ray images reflected in his glasses.

“I’m not the enemy, Catherine,” he said softly, not looking at her but focusing instead on the light box. “I wish I could make you believe that. I keep thinking there’s got to be something I did, something I said, that’s changed things between us.” At last he looked at her. “We used to rely on each other. As partners, at the very least. Hell, the other day, we practically held hands in that man’s chest! And now you won’t even let me cover for one patient. By now, don’t you know me well enough to trust me?”

“There’s no other surgeon I trust more than you.”

“Than what’s going on here? I get to work in the morning, and find out we’ve had a break-in. And you won’t talk to me about it. I ask you about your patient in Bed Twelve, and you won’t talk to me about her, either.”

“The police have asked me not to.”

“The police seem to be running your life these days. Why?”

“I’m not at liberty to discuss it.”

“I’m not just your partner, Catherine. I thought I was your friend.” He took a step toward her. He was a physically imposing man, and his mere approach suddenly made her feel claustrophobic. “I can see you’re scared. You lock yourself in your office. You look like you haven’t slept in days. I can’t stand by and watch this.”

Catherine yanked Nina Peyton’s X ray off the light box and slid it into the envelope. “It has nothing to do with you.”

“Yes, it does, if it affects you.”

Her defensiveness instantly turned to anger. “Let’s get something straight here, Peter. Yes, we work together, and yes, I respect you as a surgeon. I like you as a partner. But we don’t share our lives. And we certainly don’t share our secrets.”

“Why don’t we?” he said softly. “What are you afraid of telling me?”

She stared at him, unnerved by the gentleness of his voice. In that instant, she wanted more than anything to unburden herself, to tell him what had happened to her in Savannah in all its shameful detail. But she knew the consequences of such a confession. She understood that to be raped was to be forever tainted, forever a victim. She could not tolerate pity. Not from Peter, the one man whose respect meant everything to her.

“Catherine?” He reached out.

Through tears she looked at his outstretched hand. And like a drowning woman who chooses the black sea instead of rescue, she did not take it.

Instead she turned and walked out of the room.