The Fifth Vial

by Michael Palmer

  “That’s not your decision to make, Doug.”

  “Isn’t it? You know, until recently, I actually tried to stick up for you. There was another candidate—a laborer, who was an eleven out of twelve match for our man. But then, when you showed how crass and arrogant you were by trying to stab Dr. Renfro in the back and subsequently getting kicked out of school and your residency, it was clear you had denigrated yourself, and lowered yourself far beneath any Guardian.”

  “Guardian? Guardian of what?…What in the hell are you talking about?”

  “I wouldn’t expect you to know.”

  “What kind of guardian?…Hey, wait a minute, are you talking about guardians as in Plato’s guardians? The philosopher kings? Surely you don’t think that you…Oh, but you do, don’t you? You consider yourself a philosopher king.” Natalie knew that in her campaign to disrupt and rattle the man, she had just been given a weapon. “How many of you are there, Doug? How many philosopher murderer kings? Are you part of some sort of secret society—a Plato club?”

  Berenger’s expression left no doubt that he had been gored.

  “You are in no position to be mocking,” he said. “The Guardians of the Republic are among the greatest, most talented, most enlightened men and women on earth. By taking over the decision-making relative to the allocation of organs, we have done more good for mankind than you could ever imagine.”

  “The Guardians of the Republic! Oh, this is too much! Do you have an anthem, Doug? A password? A decoder ring? How about a secret grip and merit badges?”

  “Enough!”

  Berenger took a single step forward and slapped Natalie across the face with all his strength, dropping her to one knee.

  Natalie, her eyes watering from the blow, ran her tongue over the corner of her mouth and tasted blood.

  “That was brave, Doug,” she said, standing. “I hope you broke your hand.”

  “No such luck.”

  “Too bad. So, tell me, what harm did that poor woman in there ever do to anyone that would cause your precious Guardians to sacrifice her?”

  “You’ll never understand.”

  “Try me.”

  “She’s a Producer—the lowest of all social groups. Compare the value of her life to that of the great man she is about to save. Either she must die, or he must. It’s as simple as that. And I say it is no contest. Organs must be allocated to save the lives of those who can and will best serve mankind.”

  “You left out the part about being able to pony up a gazillion dollars as well.”

  “Wrong! Many of the Guardians we save don’t have that kind of money.”

  “Such charity. And here I was so surprised and proud of you when you put Tonya in her place and treated that poor fellow who couldn’t stop smoking so humanely.”

  “If you hadn’t been standing there I would have kissed Tonya for being so right on the mark. I wanted to kill that bastard Culver for wasting that heart. I wanted to kill him on the spot. I wanted to open his chest with a dull blade, remove that precious heart I had been forced by the system to place there, and put it into someone who deserved it more and would take better care of it.”

  Out of the corner of her eye, Natalie could see that Luis had reached his gun and was slowly maneuvering it to where he could pull it from beneath his leg. His color had, if possible, worsened, and his eyes looked nearly lifeless. Nearly.

  “So, Douglas the Great,” Natalie said, “the reason you didn’t just have me killed and buried down here is…? No, wait, don’t bother answering, Lord Philosopher King. I know. I’m alive just in case, by some fluke, my lung is rejected or fails to function for whatever reason, you want me incubating the other one.”

  “How long is this poison going to last?” Berenger demanded.

  “I would say go fuck yourself, but I have high hopes of being elevated to the exalted ranks of Guardian once more, and I wouldn’t want to say anything so crude that it hurts my chances.”

  Natalie could see that the corner of Berenger’s eye had begun to twitch. Another hit. Turning his back on her, he ordered Santoro to his feet.

  “Come on, Xavier, I need you in the OR.”

  Santoro tried to stand, slipped on the products of his own sickness, fell, and began to giggle and moan at the same time. At that moment, a helicopter swung low over the hospital, then off to the landing strip. One of the soldiers was dispatched to guide the latest arrivals in.

  “Damn it, Santoro!” Berenger snapped. “Get up, get showered and dressed, and get ready to assist me in the OR!”

  He grabbed the man by the back of the shirt and pulled him rudely to his feet. The cleansing shower would never happen. Luis raised his gun and, before either of the remaining two soldiers could react, fired from twenty feet away. The bullet caught Santoro squarely in the chest, knocking him back into an easy chair, an odd smile on his lips. A second shot, probably meant for Berenger, shattered a window.

  “No!” Natalie screamed as the two soldiers riddled Luis with automatic fire from their machine guns, causing his body to jerk about like a marionette. “No!”

  Natalie wanted to rush to him, but in truth, there was nothing she could do, and the Arab soldiers were extremely jittery. Instead, she moved off to one side and satisfied herself that her hero was at least at peace, as she, herself, would undoubtedly be before too much longer.

  Berenger was clearly unraveling. He stormed over to where Vincent’s girlfriend lay, violently snapping her head and kicking her feet at whatever hallucinations were harassing her.

  “Who are you? What are you doing here?”

  The woman glanced up at him and began laughing hysterically. Then, without warning, she threw up, spattering his shoes. Contemptuously, he wiped them on her pants leg, and then turned toward the patio entrance where three soldiers rushed in wheeling a stretcher on which lay a young, copper-skinned, mustachioed man, with a portable monitor-defibrillator and oxygen mask in place. His breathing was labored. Behind him came an Arab physician in scrubs and a white coat, and a young, lean, black man pushing a small, glass-front case, mounted on wheels, and containing a number of units of blood.

  “You’ll be working in OR one as usual, Randall,” Berenger said to the man. “The bypass pump is just as you left it. You know where everything else is. Be careful getting ready, but do it quickly.”

  He patted the pump tech on the shoulder, hurried over to the prince, and listened to his heart and lungs.

  “I don’t like this,” he said to the physician in English. “I don’t like this at all. Where are Khanduri and the nurses?”

  “We flew over them. They’re in two cars, about five miles from here—on that winding road, half an hour, maybe. No more than that.”

  “You should have put them all on the jet and flown straight in.”

  “You heard the pilot back in Rio. He said the flaps weren’t working right, and it was too dangerous.”

  “Christ. When did the prince start to slip?”

  “At the airport, just as we were transferring him to the helicopter.”

  “Okay, okay, we can still pull all this together. Can you assist me in the OR?”

  “I dare not leave the prince, especially when he is in this condition.”

  “All right. Get him into the recovery room and see what you can do to stabilize him until Khanduri gets here. Wait, what’s the minister’s name?”

  “Minister al-Thani.”

  “I’m going to ask him if he can assist me in the operating room.”

  “I don’t think that would be proper, no matter what,” the physician said. “He is—”

  “I need help, damn it! I need another pair of hands, even if the person they’re attached to doesn’t know anything about—No, no, wait. Never mind. Just get the prince onto the monitor in the recovery room and get him stabilized. I’m going to get started and have the heart harvested and ready when Khanduri and the nurses arrive.”

  “But who will assist you?”

 
Berenger actually may have smiled.

  “She will,” he said, pointing at Natalie.

  Forty

  An enemy…owes to an enemy that which is due or proper to him—that is to say, evil.

  —PLATO, The Republic, Book I

  “You’re out of your mind!” Natalie cried out. “I’m not going into the operating room to assist you. Not now, not ever. I’d rather die.”

  Berenger, almost invariably composed, suave, and in control, was clearly rattled by the sudden downturn of his patient, the violent death of Xavier Santoro, and Natalie’s constant sniping. She was pleased to see that the tic at the corner of his eye had, if anything, intensified.

  “Actually, Natalie,” he said, his teeth nearly clenched, “it’s not going to be you who is doing the dying—at least not yet.” He bent down and picked up Vargas’s pistol. “It’s going to be them.” He gestured to the kitchen and maintenance crews. “If you aren’t in clean OR scrubs, prepping your hands within two minutes, I will begin at the end of this row and will kill one of them every minute until you comply.”

  “But—”

  “There’s more. If you don’t assist me, I will have to use Dorothy, my anesthesiologist. And before I do that, I will have her strap the patient down and allow her to wake up. Then we will harvest her heart.”

  “Jesus, Doug, what are you?”

  “Right now I’m a man who needs to get things done in a hurry. Are you in?”

  He casually aimed the gun at one of the chambermaids, a pretty Indian woman who couldn’t have been more than sixteen.

  “The Philosopher King,” Natalie muttered as she turned and headed for the operating room.

  Berenger followed her.

  “There are scrubs for us in that cabinet,” he said. “We can change in recovery room two. I won’t peek if you don’t.”

  “Peek all you want.”

  “My second surgeon and the nurses should be here any minute. Then I shall have all the help I need, and you can return to the others knowing you have saved many of their lives.”

  After getting their masks and surgical hair covers in place, he led Natalie into the narrow scrub room, set between the two ORs, and nodded her toward the second of two stainless steel sinks. As they washed with antiseptic-impregnated sponges, her mind was consumed with finding a way to kill him. Antonio Vargas, and probably Luis as well, were killers by their nature, but this beast and his fanatic Guardians killed by choice. Put a gun in her hand, and she would have no trouble pointing it at her former mentor and role model, and pulling the trigger.

  “And so,” he was saying, “at the very core of the Guardians is Plato’s concept of the Forms—his determination that perfection is inborn in the Guardians. He used this concept to conclude that the soul of such as us must be immortal, because how else could the notion of what perfection is be present at birth?”

  “It’s been a while since I took philosophy at Harvard,” Natalie replied, “but from what I recall, I don’t think you’ve got it quite right. The only perfect thing you Guardians are doing is being perfectly immoral.”

  In the mirror, Natalie could see the tightness and tension in Berenger’s eyes.

  Keep jabbing, she told herself. Whatever you do, keep jabbing.

  “The Forms tell me otherwise,” he replied. “Our organization has prospered and has benefited millions and millions of the citizens of the world at very little cost. People will never know whose music is being brought to their ears because of us, or whose buildings they are marveling at that would never even have been conceived of. They will never know that the lifesaving drug they are taking was developed because we were able to supply its creator with the perfect organ at the perfect time. You see, dear Natalie, the Guardians are all about perfection and the Forms. Now, let us harvest our heart and place it where it belongs and where it can do the most good.”

  “How about we harvest yours instead?” she suggested.

  At that moment the door to the scrub room burst open and Randall, the heart-lung bypass pump technician, rushed in.

  “The pump is ready, Doctor,” he said.

  “Any sign of Dr. Khanduri or the nurses?”

  “None. Dr. al-Rabia says to tell you the prince is slipping.”

  “Damn it. Go have a chopper sent up to find out where the others are, and then get ready. If necessary, we’ll put the prince on the bypass pump right now and just keep him there. Meanwhile, I’m going to get started next door. Come on, assistant, let’s get cracking.”

  Berenger followed Natalie into the OR, where the anesthesiologist, having put their patient to sleep and intubated her, helped them gown and glove. Seeing Sandy Macfarlane looking so serene, Natalie felt a trickle of relief make its way into her profound sadness. She remembered asking the anesthesiologist, only partly in jest, just before her Achilles tendon repair, “How am I going to know if I didn’t wake up?”

  The man merely smiled down, patted her on the arm, and injected the pre-op meds. It was totally disheartening to possess that information about Sandy, and to be helpless to do anything about it.

  Hey, Doc, tell me. How am I going to know if I didn’t wake up from my surgery?

  “Dorothy, are you all set?” Berenger asked. “We’ve got to move on this one.”

  “All set.”

  “Do you have ice ready? There’s going to be a delay between the harvest and the transplant.”

  “Always.”

  Natalie again looked across at Berenger’s eyes. He was clearly frazzled, but for twenty years or more he had been the Man outside of and within the OR, and had successfully handled countless medical crises.

  With no nurse to assist them, the anesthesiologist had pulled two large instrument stands across the operating table so that both surgeon and assistant could get at them. Doug Berenger was not only one of the most elegant, brilliant surgeons Natalie had ever seen, he was one of the fastest. Without asking for her help, he began rapidly swabbing russet-colored Betadine antiseptic over Sandy’s chest.

  “Let me tell you one last time, Natalie, if you make any odd or unusual moves, any at all, I will tell Dorothy over there to turn off the anesthesia before we proceed. Have I made myself clear?”

  “Clear.”

  “Then just shut up and do as I say. Have sponges and hemostats ready just in case. Dorothy, we’re opening.”

  As Natalie picked up what Berenger asked for, she noticed three scalpels lying side by side on the far edge of the instrument tray. There was no way she could get at them without being seen, but there was also nothing else available that even looked like a weapon. A desperate situation called for desperate measures, and one way or another, she also knew that, like the poor woman on the table, she wasn’t going to wake up from her operation.

  Without another word, Berenger snatched one of the scalpels from the tray and made a foot-long incision from top to bottom along Sandy’s sternum. Blood instantly began oozing from a dozen or more small vessels, but unless one of them began hemorrhaging rapidly, Berenger would not bother to gain control.

  There was no need.

  “The bone saw is right there, Natalie. So are the spreaders.”

  Natalie felt sick as she reached for them.

  The operating room door opened. Berenger turned to see the Arab physician, al-Rabia.

  “Dr. Berenger,” the man said urgently, “the prince’s blood pressure is zero. I cannot bring it back up.”

  The few seconds Berenger was distracted were enough. Natalie swept her gloved hand across the two remaining scalpels and came away with one of them tucked in the sleeve of her surgical gown. Then she glanced over at the anesthesiologist to ensure that she, too, was focused on al-Rabia.

  Now, her mission was clear—somehow to get close to Berenger, and then, for Rosa and Luis and Ben, and herself and all the other victims of the Guardians, to be fearless.

  Berenger was clearly on edge—the juggler of balls, who had just reached a personal best when one more was throw
n into the mix.

  But he was still the Man.

  “All right, Doctor,” he said, “let’s wheel him quickly into the OR, and I’ll get him on the pump. Dorothy, just leave the gas on here and come with us. Natalie, let’s go, we have work to do.”

  Berenger took a step toward the door, then another. Natalie, moving from the other side of the table, was now a pace behind him.

  There is often only one chance.

  With Luis’s words resonating in her mind, she slipped the scalpel into her hand.

  “Doug!”

  Startled, Berenger turned toward her, exposing his jaw and the side of his neck.

  Fearless!

  With all the force she could manage, Natalie swung the blade up from her hip and swiped it viciously across Berenger’s throat. Instantly, the opening of his severed trachea appeared where his larynx had been. A moment later, bright crimson arterial blood began spewing from a laceration through his carotid artery, splattering Natalie, and coating the floor.

  Unable to speak, pawing futilely at his neck, the man called Socrates, one of the founders of the Guardians of the Republic, lurched backward and fell heavily, awash in the rapidly ebbing essence of his being. His last moments were spent staring up at Natalie in silent, absolute, wide-eyed disbelief.

  “Come, Dr. Berenger!” al-Rabia cried from the OR next door. “The prince’s heart has stopped! Come quickly!”

  Natalie stripped off her gown and raced in to help, but she knew that unless the dysfunctional muscle that had caused the prince’s heart failure could be replaced, there was nothing that drugs or cardiac compressions could do.

  “Oh, dear Allah!” al-Rabia kept muttering. “Dear Allah, help us!”

  Natalie continued performing CPR, but the cardiac monitor remained absolutely discouraging. She considered trying, with the help of the pump technician, to hook him up to the bypass machine, but her knowledge and surgical skill stopped well short of that. Al-Rabia, clearly a gifted physician, tried several shocks from the defibrillator, even though he knew that his master’s problem was not fibrillation—a potentially reversible lethal rhythm—but rather, complete cardiac standstill—a virtually untreatable flat line. There really was no hope.