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IN MEMORIAM
WILLIAM HENRY FLETCHER, PH.D.
1940–2008
To Evelyn
Who is more patient than she knows
ACKNOWLEDGMENTS
Heartfelt thanks to Al Zuckerman at Writers House, the midwife of my first baby and the best writing teacher I’ve ever had. Thanks also to Bob Gleason at Tor, for getting it; to Beverly Martin, for help at a crucial time; to Kate Flora, for her trenchant critique; to Leonid, my first and most faithful reader; and to Olga and Sasha, for believing in me. I owe a great debt, too, to the late Ray Bradbury, who, apart from being one of the idols of my youth, once gave me a piece of advice that ought to be engraved in gold: “Just do it!”
CONTENTS
Title Page
Copyright Notice
In Memoriam
Dedication
Acknowledgments
7:25 A.M.
7:45 A.M.
8:24 A.M.
10:07 A.M.
10:55 A.M.
11:38 A.M.
12:31 P.M.
1:20 P.M.
1:32 P.M.
2:05 P.M.
2:55 P.M.
3:15 P.M.
3:54 P.M.
4:02 P.M.
4:44 P.M.
5:15 P.M.
5:40 P.M.
5:55 P.M.
6:29 P.M.
6:42 P.M.
About the Author
Copyright
7:25 A.M.
The Huns had taken the citadel of Neurosurgery I. For the rightful denizens of the operating suite—the scrub nurses, anesthetists, residents, postgraduate fellows, and technicians—it was an invasion, a desecration of the Holiest of Holies. Not once in the ten years of its existence had this quiet cluster of green-tiled rooms been so jarred and trampled as now, by this troop of camera operators, lighting men, gaffers, grips, and gofers, bustling back and forth between the scrub room and Operating Room Three. Masquerade as they might in blue scrubs and gowns, shower caps and paper booties, it was obvious that not one of them knew the rules—what could or could not be touched, or where the sterile fields began. They were like monkeys swinging from the glass trellises of a chemistry lab. It was an invitation to disaster.
So thought Ali O’Day, Assistant Professor Neurosurgery, as she looked through the large picture window above the scrub sink while she rubbed a foamy antiseptic brush between her fingers and over her arms up to the elbows. With a mixture of disdain, curiosity, and envy, she watched the film crew hovering about Kathleen Brown, the network’s field correspondent, aiming their silver-and-white reflectors at her impossibly perfect skin and hair as they ran through a lighting check. A man with a Betacam on his shoulder was panning the cramped operating room and talking to New York through a Bluetooth headset clipped to his ear.
It was history in the making.
History in the making. She had heard it repeated over and over, like a mantra. It might even have been true. But at this moment, all she could think of was how to keep from vomiting into the sink.
“Nerves?” asked Florinda, the circulating OR nurse, as she passed with a cart full of instruments.
“Mm-hmm.” Ali faked a smile as she leaned against the rim of the sink. If only nerves were all it was. The sweet lemon scent of the hand soap did nothing to conceal the smells of iodine and alcohol, and the mixture of all three together roiled her stomach. She stepped back from the sink and closed her eyes. Someone was shouting in an unintelligible Eastern European accent—something about power, a power cable, a power box. She heard the five-minute scrub timer ding. And then she heard a voice from on high—the voice of the god of the neurosurgical operating suite, Dr. Richard Helvelius himself.
“Th-that had better be one of your yoga exercises, Dr. O’Day.” He spoke with a slight stutter that was almost Apollonian in him, as though it proved how carefully he weighed and sifted every word. “Tell me you’re p-priming your mind for its encounter with destiny.”
“You know what it is,” said Ali, frowning at his tease.
“You mean you haven’t … I, uh, I thought you had…”
She opened her eyes and looked at him, his head bent slightly toward her from his six-foot-four-inch height. Seen from this angle, his craggy features softened, and that famed aquiline nose of his relinquished its all-powerful pugnacity. It was just his big blue gray eyes she saw—the eyes she had fallen in love with.
“I’ve been a little tied up, setting the stage for your big show,” she said. “Destiny is hard work, Richard. I’ve hardly slept in four days.”
Helvelius laid his strong, warm hand against her spine and gently pushed her back to the scrub sink, back to the iodine and the alcohol and the sickening-sweet lemon scent. He bent even lower to speak confidentially into her ear. “I appreciate that, Ali. In fact, I’m a little w-worried for you.”
“Don’t be,” she said. “I’ve scheduled a quiet little D and C tomorrow, after all the hullabaloo dies down. Ute Heckart from Perinatal’s doing it. She’ll be very discreet.”
“And you’re still sure that’s what you w-w-want?”
“Don’t talk about what I want.” Ali involuntarily touched the back of her hand to her mouth, undoing her five-minute scrub. “It’s for the best,” she mumbled.
“It doesn’t have to b-b-be like that. This b-baby could be good for us.”
Ali clamped her eyes as a new wave of nausea hit her. “Please don’t call it a baby,” she said through clenched teeth.
Helvelius opened his mouth to speak, but was cut off. Kathleen Brown’s skin tones and hair were perfect at last, and the crew director had just gotten the thirty-second signal from New York. Helvelius was hastened into the operating room by one of the Huns, a young man in thick glasses and an oversized yellow surgical gown.
“You, too, Ali,” said Helvelius, looking back at her. “We’ll scrub in later.”
Ali followed him, stooping through the tangle of cables and plastic tubing, holding her dripping wet hands in front of her chest. Helvelius was led to a place on one side of the narrow surgical bed, opposite Kathleen Brown. On the bed sat a boy of seven, who seemed dwarfed by all the cameras and monitors. He had a round, beautiful face, with healthy pink cheeks and a snub nose that wiggled as he chewed pensively on his lower lip. The back of his head had been shaved, leaving a halo of curly white blond hair. His forehead and scalp were dotted with little squares of white tape, from which dangled green, red, and yellow wires.
The excited grin on the little boy’s face coaxed a smile from Ali. As she passed, she bent to one side and whispered a greeting to the young patient, who laughed in return. But there was no time to talk. Someone reached under her elbow and ushered her to a position behind Helvelius, close to a high blue-cloth-draped table covered with stainless steel instruments, outside the line of view of the camera.
Although a small TV monitor beside her seemed to show a nearly empty operating theater, that was a trick of the camera angle. The room was actually so packed with crew and gear that Ali could barely see the operating table. She strained to get a better view. She had come in at 6:00 A.M. to police the setup of the film equipment, laying down red tape
on the floor to mark off sterile and nonsterile areas. Now she had no way of telling whether her lines were being respected. Still holding her hands in front of her, Ali tightened her fingers into fists as the crew lurched into action around her. Lights blinked, hand signals waved, and on every side technicians darted back and forth or crouched on taut haunches. It was like standing in the middle of a beehive—an anarchy of buzzing and bustling. There was nothing she could do about it. She had been reduced to a bystander in her own operating room.
Ali squinted under the sunlike glare of the reflectors. Across the table, Dr. Helvelius and Kathleen Brown could not help blinking. But the young patient at the epicenter of all this hurly-burly did not blink at all.
The voice with the Eastern European accent was heard again, counting backward, “Fifteen, fourteen, thirteen, twelve…”
On the TV monitor, Ali watched the live broadcast of America Today from New York. The network anchor Amy Richmond was talking from her desk. Behind her was a still shot of the three gleaming steel-and-glass high-rise towers that were the core of Fletcher Memorial Medical Center, which she could hear being described as “the sprawling flagship hospital of one of the oldest medical schools in the country.”
“We have an unprecedented entrée today into the leading edge of medical research, where Dr. Richard Helvelius and his team in Chicago are about to perform a groundbreaking operation. If all goes according to plan, it could be a day to rival the first operation under ether in 1846 or the first heart transplant in 1967. After today, ethicists and philosophers will be on the airwaves, arguing about how the very concept of mortality will have to be redefined.…”
Ali scowled. Yes, yes, history in the making. Glory, priority, celebrity—that’s what mattered to these Huns, with their cameras and microphones and perfect hair. They worshipped fame, and they expected to share in it, because they were the first to spread it over the airwaves. But what if all didn’t go according to plan? What would their story be then? Would that still make history?
Amy Richmond went on talking. “Our network news team will be covering every phase of this momentous undertaking, beginning with our live segment on America Today, and continuing with a full hour update on our Emmy-winning newsmagazine Lifeline, at nine o’clock Eastern tonight. For more, let’s go to Kathleen Brown, who is in the operating room right now.”
At a cue from the crew director, a small light on the Betacam went red, and Kathleen Brown began to speak.
“Hello, Amy. You’re right. History is about to be made today here at Fletcher Memorial. With me is Dr. Richard Helvelius, the chairman of the Department of Neurosurgery, a pioneer in the treatment of patients with brain tumors and spinal cord injuries. Dr. Helvelius?”
On the monitor, Ali saw Helvelius smile. “Good morning, Kathleen. Hello, Amy,” he said. “This is an exciting day for all of us.”
Ali noticed that Helvelius was speaking in his lecturing voice, pitched a little higher than his usual gravelly baritone. It had always amazed Ali that the stutter that Helvelius had in normal conversation disappeared completely when he spoke in public.
“And who is that with you?” asked Amy Richmond.
“This bright young man is Jamie Winslow, a patient of mine. America is looking on, Jamie. Do you know what a TV camera is?”
“It’s a machine that can see for people that can’t be here. TV is just like radio, except they have SpongeBob and Yu-Gi-Oh!”
“There’s a TV camera pointing at you right now. Is there anything you’d like to say to anyone out there?”
“Just hi! To Mrs. Gore and Mr. Tabor and Mrs. Rutledge at the Grossman School, and to my friends, Judd, Rog, and Felipe. This place is awesome, guys. What they do in this operating room rocks.”
“Thank you, Jamie.”
“Oh, can I say one more thing?”
“Sure, Jamie.”
“This is for the Cubs—hang in there. Miracles do happen. If I can do it, you can, too.”
Helvelius shook his head with the gravity of a doctor at the bedside of a hopeless case. “I’m sorry, Jamie. The Cubs may be beyond the help of medical science this season.”
Jamie laughed, and his laughter ran like a ripple through the room, clearing the air of tension. The nurses and camera crew laughed with him. Even Dr. Helvelius laughed. But Ali didn’t so much as crack a smile. Jamie’s very life was at stake, and there was so much that could go wrong. She knew that the distraction of a single second could spell the difference between triumph and catastrophe.
Resuming his professorial tone, Helvelius turned back toward the camera. “Jamie is blind, and has been since he was three years old, when he developed a benign growth in the brain called an AVM, or arteriovenous malformation. It’s basically a knot of expanded blood vessels that looks and feels just like a handful of worms. In Jamie’s case, it’s grown to about the size of a lemon, and it’s sitting in the occipital lobe, the hindmost part of the brain, which is the primary center for vision. We’ve already taken out part of the AVM in two earlier operations. Today, we’ll take out the rest, and then … and then we’re going to put something new in its place.”
“Just what is that, Dr. Helvelius?” asked Kathleen Brown.
“We call it the SIPNI device. That’s short for Self-Integrating Prosthetic Neural Implant. You see, the AVM long ago destroyed Jamie’s visual brain center. Even with the AVM removed, he will still be blind. What the SIPNI device does is substitute for the missing part of his brain.”
“How is that possible?”
“Well, SIPNI is a kind of minibrain in itself. It’s a very special type of self-contained computer.”
Helvelius pointed to the device, wrapped in a blue envelope with a clear plastic window and sealed with what looked like striped masking tape. The camera showed little but the glare of the plastic, but Ali knew well what was inside. It was the size and shape of a robin’s egg. Its surface was darkly metallic, reflecting light from thousands of honeycomb facets, like a diamond wrought by a fairy gem cutter. It had cost much more than any mere diamond, too—millions in government and industry grants, years of toil, brains and bodies worn out from nonstop work—and, not least of all, relationships strained to the breaking point.
But Helvelius did not speak of the cost. “Don’t let its small size fool you,” he said. “It uses a parallel array of miniaturized nanochips, with as much sheer calculating power as a conventional minicomputer. It can perform all the image-processing functions that Jamie needs to be able to see. But the really astounding feature is the software that operates it. That’s something we’ve developed here at Fletcher Memorial. It represents a major breakthrough in artificial intelligence.”
The camera switched from a close-up of the bag containing the SIPNI device to Helvelius’s face. Ali felt a twinge of jealousy as she saw how aroused Helvelius was by the camera. His eyes positively sparkled. His straight, wide, thin-lipped mouth moved vigorously, baring his lower teeth with every “e” and “w” he spoke. A shock of gray hair, still bearing traces of black, wagged over his high forehead. Even his face’s anchor, his grand patrician nose, came alive, nostrils flaring.
Yesterday, no one but Ali could have moved him so deeply. Today, the Jezebel’s eye of history had stolen his heart.
Helvelius led with his chin as he spoke. “You see, SIPNI can learn, adapt, and model itself, based on the input it receives from Jamie’s brain. That’s exactly what it needs to do, if it’s going to reach out and reconnect with all those millions of brain cells that once converged on the visual center. Not just the fibers from his optic nerves, but also those involved in remembering images, or coordinating hand and eye movements, or joining mental pictures to emotion or to the senses of hearing and smell. We can’t begin to untangle the complexity of all that signaling and countersignaling. But SIPNI can do it.”
“You mean it can think?”
“In a way, yes. For that, you might ask Kevin—Kevin O’Day, that is—our resident artificial intelligenc
e expert. Kevin, does SIPNI think?”
“Aye, verily, milord,” came a voice from across the room.
Ali shuddered. Like a blue note in a Mozart sonata, the sarcasm in Kevin’s answer jarred everyone in the room. Kathleen Brown’s mouth hung open unflatteringly. Dr. Helvelius tore off his glasses, as though he were going to throw them. “Look, K-Kevin—” he began, but words failed him.
The camera cut abruptly to a thirtysomething young man in dark-rimmed spectacles who sat at a computer console across the room. Ali’s heart sank as she saw the patronizing smirk on his face. She recognized that look. She had been married to Kevin O’Day for five years. She knew that look meant trouble.
Like everyone else, Kevin O’Day was dressed in regulation blue scrubs. But instead of the standard blue shower cap, he had covered his hair with a yellow and green silk Japanese head scarf. Although his fine and regular features appeared ordinary from a distance, close-up he was strikingly handsome, even beautiful, with penetrating blue eyes that contrasted with his red goatee and the slight orange freckling of his skin. His bare forearms could have modeled a lecture in topographic anatomy, with their sharply incised muscles and tendons almost popping through the skin. They were, as Ali well knew, the forearms of an accomplished rock-climber who could effortlessly haul himself up by line and piton.
Kevin kicked his chair away from the console, as though he were swinging around to face Kathleen Brown, but he never really looked at her. His eyes stayed focused on the computer monitor, as though this were the only thing worth his glance. “Everyone’s all gaga that a machine can think. Why is that so hard to accept? The human brain itself is a machine—nothing more than a computer hardwired with blinking neurons instead of vacuum tubes or silicon. What’s so special about a neuron? At over a thousand cubic microns, it’s bulky as hell, and it requires an enormous expenditure of energy just to stay alive and hold a place in the big net. SIPNI beats that hands down. Not only does it think, but it thinks faster and more elegantly than the brain tissue it replaces.”
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