Perfect Killer
Page 17
the gold Piaget on his wrist. "Yes, yes," he mused to himself. "That would have been
about the time you were in the first grade and we were giving everybody Salk vaccines. I
remember one other time your mama brought you in bleeding like a stuck hog where you
had stepped on some glass barefoot." His eyes went distant for a moment and I sensed he
was watching some version of the same memory in my own head where I'd played in tall
grass down by Riverside Drive near Eddie Stanton's house, I thought for sure I had been
bitten by a water moccasin and was going to die right there.
"Your mama had a cute little Nash Rambler and you lived in the Judge's house
then. Lordy, your mama sure was proud of you." His face went blank for a moment and
showed me his professionally sympathetic gaze. "I sure mourned her passing." He nodded
again, then returned to studying my face.
"Yes, yes, you certainly do have the Judge's eyes." Then he laughed. "Fortunately
for you, you don't have his hairline." He combed his aristocratic fingers through his white
thatch. The Judge had been cue-ball bald.
Claiborne mined this particular historical vein for another eternal ten minutes
before finally asking me what had brought me into his office. "Got just the thing." I followed Claiborne to the radiology department.
"We've got a terrific system allowing us to send digitized X-rays and scans down
to the medical school in Jackson for consultation, or Ocshners or anywhere else for that
matter."
I followed him through the waiting room, smiling and nodding politely as he
introduced me in glowing terms as a local boy made good, all the while letting everybody
know I was the Judge's grandson and he had been my physician. Somehow that seemed to
matter, and once again it astounded me how eagerly people here allowed their lives to be
shaped by dead men.
We made our way to the back corner of a long, claustrophobic supply closet,
where we found a young man in a white coat intently tapping at a keyboard. A giant, highresolution, flat-panel plasma screen dominated the room.
Claiborne cleared his throat. "Tyrone?"
The young man turned toward us.
"Tyrone Freedman, this is Dr. Stone. He's one of my old patients, but he's from
California now." Claiborne said nothing about the Judge this time.
When Freedman stood up and shook my hand, I tried not to look at a ragged scar
that puckered its way from the corner of his left eye and made it across his temple before
disappearing into his hair above his ear.
"Tyrone here is a surgical resident from the University Medical School, a local boy
who proves Valley State can produce more than famous NFL stars. He wants to be a
trauma surgeon." Claiborne paused. "We have plenty of practice for him unfortunately." "Pleased to meet you," I said
"Likewise," the young man said.
"Dr Stone wants to know if we can help him view some scans from back in
California."
A smile broadened Freedman's face. "Of course we can."
"Tyrone's something of a computer genius," Claiborne said. "He was actually a
programmer before premed."
Freedman nodded.
"Well, that's beyond this old country doctor," Claiborne said as he sidled his way
out of the confined space. "Tyrone, you take good care of Dr. Stone so he'll have nice
things to say about us when he gets back to Los Angeles."
Tyrone turned to me, "Okay, Dr.—"
"Please call me Brad."
The young man gave me an odd raised-eyebrow look, then nodded. "All right, uh,
Brad. Let's get down to it. What site do we head to first?"
"Head to http://ConsciousnessStudies.org —three s's in the middle—and click on
the private data link."
Instants later, my Web site appeared. Tyrone brought up the account entry box
when he clicked on the data link.
"My user name is bstone, password, jambalaya."
"Those are way too obvious," Tyrone said. "I mean, my apologies, but anybody
who wants into your private data would be deterred by like ... seconds."
"You're right," I said as the scan files began downloading.
"You want me to change it for you?"
"Let's wait."
Tyrone shook his head. "What do you want first, the MRIs, the PET, or the EEG?" "Let's do the EEG."
If you want privacy, I can show you what to do and leave."
I thought about this for a moment. "I can walk you through things if you're
interested,"
"Wow? Really?" He turned and looked up at me. The scar presented itself again.
He caught my glance.
"Drive-by shooting," he said casually. "My own damn fault. I fell in with some
older gang members, hacked bank accounts and school grades for them. When the police
caught me, the trails all led to the gang. I needed to be zeroed out ... fourteen years old and
sitting on my uncle's front porch in Balance Due when it happened."
Balance Due had been the black section of Itta Bena. I had been a small child the
last time I'd visited there, but I still remembered the smell of raw sewage, which raised
sulfurous bubbles in the stagnant, scum-carpeted ditches alongside muddy, unpaved roads lined with weathered wood shacks, rusted corrugated metal roofs, and wood-fire smoke
coming out of battered tin stovepipes.
"Killed my uncle and aunt," Tyrone said. "Left me with this souvenir." He swept
his index finger casually across the scar. "Made me want to be a trauma surgeon." "I thought drive-bys were a big-city thing."
He shook his head and returned to the keyboard and display, talking as he worked.
"Every small town in the Delta has got its Crips and Bloods, or a bunch of drug-thug
wannabes who are half as smart and twice as dangerous." He paused. "That's why I live
way out in the country, at the end of a dirt road." He nodded to himself.
"What happened to the people who shot you?"
"Dead," Tyrone said without emotion. "They crossed somebody. Somebody zeroed
them out. End of story."
An instant later the EEG appeared on the screen.
"Okay, that's the new one," I said. "Can you display the reference file for
comparison?"
An instant later, we had the two files on-screen.
"The reference EEG's been consistent for almost six years, consistent with a
persistent vegetative state in this subject, a forty-four-year-old female suffering from
profound brain damage resulting from a motor vehicle accident." It felt odd to describe
Camilla in the dry, impersonal language of grand rounds, but it focused my objectivity and
made me reach deeper for details than I might otherwise have.
"Okay, you can see the new EEG from yesterday differs significantly, indicating a
substantial increase in higher brain function."
"How do you know it's higher brain function from looking at this and not brain
stem or something else?"
"Good question." I traced the jagged-line patterns with the cursor. "Notice the P15
peak absent on one side and markedly prolonged in latency on the other." He nodded.
"And here, BAEPs show neither wave IV nor V on either side."
"Meaning?"
"I have an idea, but let's see what the scans tell us," I said uneasily. An increase in
higher brain might mean an end to her coma.
"Why would things be the same for six years, then suddenly change?" Tyrone
"Well, the patient recently suffered from a severe, antibiotic-resistant bacterial
infection resulting in temperature spikes over one hundred and five degrees. Sustained
high fever can dramatically affect the brain."
Tyrone nodded. "PET or MRI now?"
"MRI."
I grew increasingly uncomfortable as we went through the MRI and, later, PET
scans.
"It looks familiar, the pattern here," I told Freedman when we had gone over the
scans for the third time.
When I finally recognized the pattern, the significance hit me like a hammer. "Oh, Jesus," I whispered. Freedman turned in his chair, his face full of startled
concern. I grabbed the back of the chair for support.
CHAPTER 38
"Dr.—uh, Brad? You okay?" I shook my head. Freedman got up quickly and helped me sag into his chair. We remained like that as I struggled to calm my breathing. Finally, I regained control, took a deep breath, and let it out slowly.
"Can you pull up the recent EEG and PET?"
"Sure." Freedman leaned over the keyboard and brought the scans on-screen. "Here." I tapped at the monitor. "And here ... while higher brain functions are
increasing, there's no change in the activity of the lower brain and brain stem. Remember that MRI of the ventral part of the rostral pons?" As my horror grew, I struggled to keep my focus on presenting Camilla like a grand rounds patient.
"Uh-huh." "Okay, now look over here, and there's clear evidence of recovery of higher brain function, especially in areas associated with awareness and consciousness."
"So this patient is coming out of the coma?"
"It appears so."
"Induced by the fever or the bacterial infection?"
I nodded dully at the implications.
"That's good."
"Maybe," I said.
Tyrone started to ask another question, I stopped him with a raised index finger as I grabbed my cell phone and hit Jeff Flowers's speed dial. I turned to Tyrone as the phone rang.
"The scan patterns are a variation on what is known as locked-in syndrome."
"Locked in?"
"Usually from auto accident trauma and strokes, sometimes by pontine lesions, which damage specific portions of the lower brain and brain stem while leaving little or no damage to the upper brain."
Flowers answered.
"Jeff, it's Brad Stone," I said urgently. "We may have a situation."
"Let me get to a place where I can talk," he replied.
As I waited, I pointed at the MRI image on the monitor display. "Look closely at this area and the pattern of hypodensity where the tissue has been destroyed. The pattern of damage leads to quadriplegia and, depending on the extent of damage, easily leads to death without artificial ventilation. This patient's death—ah, case, I mean—did not require ventilation, but all voluntary muscle function was lost as well as higher brain functions— until yesterday."
Flowers's voice came hack on the line. "Sorry, Brad, I was in a staff meeting.
"Thanks for taking the call. Look, Jeff, I think we have a case of locked-in syndrome developing."
"Dear God."
"Yeah. Can you do some tests to make sure."
"Anything you need."
"Thanks. As you may remember, a lot, if not most, people with locked-in syndrome retain some small degree of voluntary control over eye movement or eyelid function. We know Camilla has had neither of those. We need to determine if that's changed. Additionally, we need a functional PET to determine if she's experiencing sensory perceptions—vision, hearing, touch—the whole gamut."
Any specific tests or protocol?"
"You pick it. We need to know whether she is aware and conscious even if she is unable to communicate."
Flowers's breath caught, echoing my own of a few minutes ago. "I never imagined in my worst nightmare it could come to this."
"I know the feeling."
"Okay. I'm on it now. Should I call you back on your cell?"
"Uh-huh. And could you upload the new scans as soon as you can." I explained my ability to retrieve them. "If for some reason you can't get hold of me, you can call Dr. Tyrone Freedman here at Greenwood Hospital." I read the number and extension off the phone. Tyrone also offered his cell number, which I passed along before ringing off.
"This is really deep," Freedman said.
I turned slowly and looked up at Freedman. "People with locked-in syndrome usually retain their ability to see, hear, feel emotions, understand spoken language, analyze complex thoughts—everything cognitively and emotionally, but all the wiring to their muscles that allows them to interact with their environment doesn't work. I'm terrified this patient's consciousness has awakened inside a black void without sight, sound, or other senses, perhaps feeling pain without any ability to express the feeling or do anything to decrease it. Something like being buried alive, but without the compassion of death to look forward to."
"Oh, man." Freedman's voice was dull, flat, and low as the implications played across his face. "I imagine hell would be a lot like that."
He opened his mouth, but before he spoke, his pager went off. He plucked it off his belt.
"Oh, great," he said as he read the text message. "All hands on deck. We've got all our ambulances filled with incoming gunshot wounds, but we don't usually staff up until after it's dark."
He turned and headed for the far end of the narrow, cramped room. "We can use all the help we can get," he said. "If you're up for it, follow me to the scrub room and I'll introduce you to the chief."
I rushed along behind him.
The wail of approaching sirens quickly disappeared beneath the urgent conversations in the scrub room. Freedman introduced me to trauma unit chief Clifford Scarborough, a tall, dark-haired man built like an NFL linebacker.
"I've read some of your stuff," Scarborough said as we soaped up to our elbows. "We're likely to have head wounds."
"I'm up for it."
"Good. It's been a bad day for serious trauma," Scarborough said. "Normally, we stabilize the most serious and chopper them down to University Med Center in Jackson, but the whole damn region's had a rash of incidents. There's not a free helicopter available. You may need to do more than help me get these people ready to ship."
"Whatever I can do."
"Okay then, suit up." He pointed toward a pile of fresh folded scrubs.
I changed, and scrubbed at my hands, forearms, and elbows. I had my gloves on by the time the triage nurse stuck her head in and said she had two she thought were DOA and six more in a hurry to get there. I took a full-face splatter shield from the scrub room nurse and adjusted it to my head as I pushed through the double doors leading to the emergency room.
The corridor beyond was packed with police and paramedics. Along the wall, two young men lay on gurneys: tall, heavily muscled, and way too young to be so completely inert. Blood dripped significantly onto the tiled floor. Uniforms filled the corridor with a blue hover as police and EMTs in latex gloves moved among their charges, working to keep more life from leaking out and on guard for violence and escape.
The doors by the ambulance dock exploded inward with two more gurneys, followed by Jasmine in a white silk blouse blossoming red with fresh blood, which covered her face and arms and matted her hair.
CHAPTER 39
Thirty-eight thousand feet over the unremarkable topography of South Dakota, Braxton's chartered 737 anonymously sketched contrails on a cornflower sky. In the front of the aircraft, tousled and rumpled reporters slumped in the forward seats and spoke wearily among themselves. The predawn takeoff from Reagan National and the three lightning-quick campaign stops in Buffalo, Duluth, and Fargo had exacted their toll.
At the rear of the aircraft in the off-limits area outside the General's private compartment, Danie
l Gabriel looked down at the towering storm clouds and chaffed at putting "retired" after the lieutenant general in his title.
He had devoted his life to the Army. His only marriage had lasted less than a year when his wife realized the military was a mistress with which she could not compete. Now, with his retirement papers grinding through the DOD bureaucracy, the change in his life gathered like the same thunderstorms assembling themselves over the prairie below.
"Retirement getting to you?" Gabriel turned as Braxton settled into a seat across the aisle. "Yes, it disturbed me as well, for months."
Gabriel felt half-dressed under Braxton's gaze.
"Yes, sir," Gabriel said. "That's most of it."
"I thought so." The General paused. "What's the rest of it?"
Gabriel looked back out the window for a thoughtful moment before returning his gaze to Braxton.
"When I was making some last rounds at the Pentagon, I paid a visit to Laura LaHaye."
"I know."
"Well, sir, I'm, uh"—Gabriel searched for the correct word—"not entirely comfortable with all the implications of the Enduring Valor project."
"What bothers you most?"
"The disclosure part, mostly I suppose."
"Disclosure?"
"To the men. The soldiers." Gabriel searched Braxton's face for a clue, but found nothing there but encouragement. "Doesn't giving them medication without telling them leave us open to charges we're performing medical experiments on people without their informed consent?"
Braxton nodded slowly "Dan, we have a life-and-death struggle to make sure our forces win every battle. If we had to have a public debate on every damned thing we do, getting a signed disclosure on every damn vitamin formula we hand out to the troops, we'd never get anything done, and whatever we accomplished would be out there for all our enemies to copy. Informed consent works fine for civilians, but when it comes to war, it would only cost the lives of a lot of brave men and women."
"But—"
"But nothing. Look, do you suppose we're telling everybody the nerve-gas antidotes we pass out contain a lot more than atropine? Or that MREs in a combat zone contain top-secret formulations designed to get the best possible performance from our boys? Which is why we don't sell those particular formulations to the public."
Gabriel nodded. "But I understand Enduring Valor has a history of side effects."