Michael Palmer

by The Last Surgeon

“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 thin
k 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.”

  CHAPTER 41

  Nick was dazed when he shut off the TV. Witnessing Umberto’s gruesome death held him spellbound, capable only of staring at his own reflection in the black television screen. He ached at the irony that Umberto’s final words had been a chilling cry for help—a cry to him.

  ¡Búsquenme al Doctor Nick Fury!

  Get me Dr. Nick Fury.

  With the man’s agonized screams echoing in his head, Nick tried to make sense of the almost inconceivable events that had occurred in the operating room three years ago. First, though, he had to begin to deal with the fact that his search was finally over. Don Reese had been right. The reason Umberto’s and Manny’s captors had not bothered issuing them new Social Security numbers was that both men were slated to die. Manny Ferris’s escape had spoiled their plan. The secret mission that was to be Umberto’s passage out of his PTSD hell had been anything but that. It had been the doorway to another, more ferocious nightmare, and ultimately the invitation to his grave.

  “Umberto,” Nick murmured, feeling intense anger searing the back of his neck.

  He stared at the screen as if the ghost of his friend was trapped inside it, marked for eternity by a video epitaph. Jillian placed her hand gently upon his shoulder.

  “Nick, I’m so sorry.”

  “What was it he said, Jill? I mean exactly.”

  “Just what you would imagine—for the Spanish part, anyway. ‘Help. Help me. Get me Dr. Fury. Get me Dr. Nick Fury.’ Even though the words were jumbled in with Umberto’s screams and with the Arabic, Belle heard and understood them, although not the meaning behind them. Later on someone must have told her about the comic book character, and she set out to understand more. Belle was all about understanding—getting to the bottom of things.”

  Jillian’s voice sounded distant—barely audible. Nick could not respond. He was already weighed down with guilt over Sarah’s death. Now this. Was there anything he could have done? It didn’t matter. The line between grief and guilt was often a very fine one. As long as the two didn’t paralyze his life, he thought now, there was no reason he couldn’t live with them.

  Eventually, the fog enveloping his thoughts began to lift.

  “Now we know,” he managed to say.

  “Now we know,” Jillian echoed softly.

  She wrapped her arms around him. At first, Nick thought he was trembling, but soon he realized that it was she. Jillian pulled away, her hands still on Nick’s shoulders.

  “I am so sad and so damn angry,” he said.

  “I know what finding Umberto alive meant to you. But you didn’t let him down. Something terrible is going on here—a secret that somebody desperately needed to keep hidden—a secret Belle paid for with her life.”

  Belle. The mention of the name jolted away what remained of Nick’s self-pity. He had to stay strong and be there for Jillian, and for himself. Of all the perils on the road to truth, one of his favorite Buddhist teachings read, the truth itself could actually prove the greatest peril of all.

  “Who would have done this?” Nick asked aloud. “It’s hard to believe his death was unexpected. There was no damn cardiac tumor. What we witnessed was an execution—a lethal charade that amounted to the ticket to freedom for Aleem Mohammad. I’ll bet that bastard was thousands of miles away when Umberto died.”

  “A very public execution,” Mollender said. “The ultimate witness protection hoax.”

  “That’s horrible,” Noreen said.

  “Belle must have been unable to let matters lie,” Jillian said. “Maybe she’s the only one who heard and understood what Umberto was screaming. Maybe she said the wrong thing to the wrong person.”

  “What we just saw ties Umberto to the Singh Center,” Nick said. “Poor Manny Ferris, too. Maybe Manny was the one who was supposed to be on that operating table, but something about his plastic surgery didn’t work out. They couldn’t make him look enough like Mohammad to pull off the switch.”

  “Possible,” Nick said. “If he were partway through a sequence of surgeries, that would explain Manny’s appearance. Listen, I know it’s painful to watch, but we might have missed something important in the initial viewing. I need to watch the operation again and maybe again. You guys don’t have to.”

  “I’m in,” Jillian said. “I’m feeling stronger than I have since Belle died.”

  “Noreen?” Mollender asked.

  “I don’t know what help I could be, and I’m really shaken up,” she replied, “but if the solidarity will help, I’ll try.”

  Noreen and Mollender stood beside Nick and Jillian, forming an arc in front of the television. Then they took their seats and Nick pressed Play. Out of the corner of his eye, Nick observed Mollender take hold of Noreen’s hand as the first images of the operating room appeared. They watched the video twice through, until Jillian broke down crying and Nick felt his own eyes begin to well. Finally, Jillian excused herself from the room—to clear her thoughts, she explained. Noreen decided to go with her. Of the four of them, Mollender seemed to be the most composed, although it was clear that he too was affected.

  “You okay to see it once more?” Nick asked.

  “It’s easier to take if I keep telling myself it’s only a movie.”

  This time, at the moment just before Umberto’s death, Nick paused the disc. Using the remote control, he advanced the video a single frame at a time, then back and forward once more.

  “Umberto grabs his head here,” Nick said, tapping his finger against the television screen. “It’s as though something erupted in his brain. I haven’t actually witnessed an aneurysm bursting in someone’s head, but a rupture like that is accompanied by a sudden, massive increase in volume within the skull. The victims experience a blinding headache, which he showed signs of having, but he wasn’t vomiting from the huge increase in intracranial pressure. A seizure is typical, too, but he didn’t have one of those either. The whole thing with Umberto took no more than a couple of minutes from beginning to end. I don’t know what else it could have been besides a ruptured aneurysm, but something seems off to me.”

  “Are you suggesting that someone might have done this to him?” Mollender asked, just as Jillian and Noreen returned.

  “I don’t know. All I keep thinking is that the surgeon could never have been allowed to open Umberto’s heart to operate because he didn’t have anything wrong with it. No tumor. Nothing. If their plan was to have it look like Aleem
Mohammad died on the table, it had to happen before his actual operation. That means someone had control of the situation the whole time.” Nick turned to Jillian. “I think Umberto was killed right there. It looks like an aneurysm, but I don’t believe it was. Someone did something to him—to his brain. Otherwise, they would have operated on his heart and found no tumor.”

  “But what about the tests?”

  “Tests can be faked. The surgeon could have been brought in to do the case on the basis of someone else’s MRI. The people who did this are no amateurs, and I would bet they have technology available to them that the average man or even doctor knows nothing about.”

  “So, who do you think is responsible?”

  Nick’s anger was pulsing through him now, driving his thoughts. Pieces of the mystery surrounding Umberto were falling into place almost too rapidly for him to integrate them.

  “You mean what person is responsible,” he said. “Or what government agency with three letters beginning with a C, that just happened, at least according to the papers, to be pumping information from one Aleem Syed Mohammad.

  “Noreen,” Nick asked, more energized perhaps than at any time since Sarah’s death, “do you have a large piece of paper and something to write with?”

  She left the room, returning moments later with a flip chart and several markers. Freezing the list of those in the OR, Nick transcribed it to the flip chart in a two-column format.

  Dr. Abigail Spielmann–Surgeon

  Dr. Yasmin Dasari-Olan–Surgical Resident

  Dr. Lewis Leonard–Asst. Surgeon

  Cassandra Browning-Leavitt–Circulating

  Nurse

  Dr. Thomas Landrew–Anesthesiologist

  Yu Jiang–Medical Student

  Roger Pendleton–Perfusionist

  Belle Coates–Nursing Student

  Kimberly Fox–Scrub Nurse

  “What are you doing?” Jillian asked.

  “These are the people who were in the OR that day. I noticed something on that last viewing, but I need to confirm it first. Jillian, I have to play some of the video again.”