He had avoided going back to his office after the debacle of the mystery crate. He needed to get out here, into the sunlight, with the breeze streaming across his face—here, where he could be alone for a few minutes to sort things out. With each drag on the cigarette, things came clearer into view.
What came into view was unsettling. Almost six hours had passed since the first bomb warning had hit his pager, and still he and the cops had very little to show for it. Fourteen search teams had failed to turn up a single trace. Lee, the expert psychologist, hadn’t dug anything out of Rahman. No one even knew if Rahman was the brains of the dog or just the tail. Did he have a confederate in the hospital? Did he have the kind of technical information that would help to locate and disarm the bomb? These were the essential questions. Now that Lee had passed the ball to the Justice Department, it could take hours to get that little piece of paper that would let Scopes and Avery interrogate Rahman the way they wanted to. Those would be hours wasted, while, for all Harry knew, the investigation might have been better off looking somewhere else.
He smelled a colossal screw-up in the making.
As he saw it, there was one good chance to cut through the impasse—Ali O’Day. Rahman seemed to hate her guts, but that wasn’t necessarily a bad thing. They were brother and sister, and there were buttons that she and nobody but she knew how to push. All the more so if there was animus between them. Anger was a button, too.
Lee was blind to this. The whole damn FBI and Justice Department had gotten to be a hindrance and not a help to the investigation. Barely four hours were left until that plane to Yemen boarded, and here they were—bogged down in paperwork.
“Fuck it,” muttered Harry. His mind was perfectly clear now, only sometimes clarity can be a bitch. There was no escape clause for this one. If the investigation was going to go anywhere, he was going to have to take the wheel and drive it there himself.
He threw down the stub of his cigarette and crushed it under his sole. Crushed it and recrushed it, long after the glow had gone out.
This could be Nacogdoches all over again, couldn’t it? he thought. Do the right thing and get crucified for it. But this was his turf and he had sworn to protect it. Two thousand lives in the balance—one piddling career was a small thing to weigh against that.
“Aw, fuck it,” he said again.
He took one last look at the sunlight, and then went in through the ER doors.
* * *
Jamie came back from Nuclear Medicine with a scan result that showed an intermediate probability of pulmonary embolism.
Dr. Brower took that as the signal to start anticoagulation therapy.
“No,” insisted Ali. “An intermediate probability scan is inconclusive. The chances of a clot are in the range of twenty to eighty percent. That’s a huge window. It could still just be his atelectasis.”
“Well, it’s all we have to go on. It’s not proof but it’s evidence. At some point, we have to actually begin treating him for something.”
“We are treating him. For seizures and cerebral edema.”
“Without success.”
“Oh, hell!” said Ali. She didn’t trust Brower. But what else had she come up with? She was angry at herself for having failed Jamie. She was desperate to do something—anything—to help him. But was she being too protective? Maternal feelings were starting to cloud her judgment, and that in itself added to the danger. “You win. But I won’t have you giving him anything more than low-dose heparin. I want to be able to reverse it if there’s a problem. Low-dose heparin, do you understand?”
Just then, the nurse at the station called Ali to the phone. It was Dr. Helvelius.
“S-sorry I took so long to get back to you. These damn pagers still aren’t working. I got called in to assist on a trauma case. Motorcycle versus SUV, with an ugly spinal fracture at C2. Took me a while to get it s-stabilized. I’m on a five-minute break.”
“We’re having problems with Jamie. He’s had a seizure and he’s in coma, no better than seven on the Glasgow scale. He’s showing progressive tachycardia and tachypnea, which could indicate brainstem dysfunction. No response to Dilantin or Solumedrol.”
“Who’s on duty in the ICU?”
“Brower.”
“Hmm. Watch out for him. He thinks of the brain as a black box. He’ll go by the book, without trying to p-puzzle things out.”
“I know. I’ve already had a tussle with him over pulmonary embolism.”
“Well, let’s reason it out. What about normal perfusion pressure breakthrough?”
“I’m worried about it. But there’s no direct evidence.”
“Why don’t we add nitroprusside, just to keep his b-blood pressure down?”
“All right.”
“You don’t sound very confident, Dr. O’Day.”
“I … I don’t know. It’s confusing. What about a blood clot, a hematoma? If there were bleeding that got missed on CT, the clot could be expanding and raising the intracranial pressure.”
“Possibly. If the ICP rises above twenty, give him a gram of mannitol. If that doesn’t do it, then we may have to take him back to the OR.”
“The AVM was so close to the brainstem, I’m afraid any problem could rapidly turn catastrophic.”
“That’s a risk we accepted when we took on this case.” He paused, perhaps expecting a reply from Ali. When she said nothing, he softened his tone. “Why don’t we have Electrophysiology come down and record some somatosensory evoked p-potentials? If we can pass a test signal from his leg through to his scalp, then that would help to show that his b-brainstem is okay.”
“Yes, that would be reassuring.”
“Do that, and call me if there’s any change. I’ll come by the ICU as soon as I’m done here.”
As he hung up, Ali realized that she had not spoken of one possibility that lurked behind all the others—that the SIPNI device itself could be causing the problem. She had tested many prototypes in animal brains without ever seeing a situation like this. But those were programmed far more simply than Jamie’s device. Was SIPNI malfunctioning? If so, it would have to be removed immediately—a critical setback to years of work and millions of dollars in expenditures, not to speak of the reputations of everyone involved with the project. The hospital’s Institutional Review Board would never permit another human trial until many months of repeat animal experiments had identified the cause of failure and proven that it would not happen again. In the meantime, the many naysayers who had opposed SIPNI would have the public forum to themselves—the America Today publicity would backfire humiliatingly—and research funding would dry up. In short, it would be a disaster. Was this why she was so reluctant to consider the possibility of a malfunction? Or was it simply a case of wishful thinking, wanting everything to turn out right for Jamie? Could she trust her own judgment when she herself had so much at stake?
Suddenly, Ali heard a bellowing sound, almost like the lowing of an ox, and looked up to see Ginnie running to Bay 7—Jamie’s bed. Jamie was moving about in the bed, but it wasn’t a convulsion—he was trying to speak.
“Daaaak! Daaaaaaaktaaa!” he groaned.
Ali rushed to the bedside.
“Jamie! Jamie!” she said. “It’s me, Dr. O’Day. I’m right here.”
His wrists were in velcro restraints, but he was jerking his fingers about as if in search of something. Ali took his hand. As soon as she did so, his movements calmed.
“Daaktaar! M-my ’ead. My ’ead ’urts.”
“Your head hurts?”
“Yaaah.”
“All right, I’ll give you some medicine to make the pain go away.” Practically all brain surgery patients came down with a headache when the anesthesia wore off, and headaches were common after spinal taps as well. So Ali was not unduly alarmed. On the contrary, she was elated to find that Jamie was no longer in a coma.
“Amadine?” he asked.
“What?”
“Amadine?”
&nb
sp; “I don’t understand.”
“Am … I … dyin’?”
“No, Jamie! Absolutely not! I won’t let you die. Do you trust me?”
There was no answer.
“Do you trust me, Jamie?”
“O-o-h-kay.”
She injected a couple of cc’s of morphine into his IV for the headache, and then ordered Ginnie to increase the Ativan to keep him well sedated. All in all, this was a good sign, she tried to convince herself. Perhaps the seizure medicine was working after all. If Jamie continued to improve, there would be no need to reoperate, and the SIPNI device could be given a chance to work.
If only it could be that easy.
When Ali had finished writing the medication order into Jamie’s progress chart, she looked up from the nurses’ desk and was astonished to see Harry Lewton standing over her.
“You again!” she said, flaring her nostrils. “What is it now? Another interrogation? Or am I to be arrested?”
Harry smiled. “Dr. O’Day, we’ve gotten off on the wrong footing. I’d like to start over again. Have you had lunch?”
Lunch? Was he kidding? He was the last person in the world she would have wanted to have lunch with. Ali snapped the binder shut and shoved it into the chart rack. “I don’t remember. I often don’t eat lunch. There isn’t time.”
“Please, let me buy you a sandwich down at Eat Street. Call it a peace offering. We can eat and talk. There are some things we need to discuss. But I’d rather not do it in my office.”
“So this is an official request?”
“Not official. But … pertinent, let’s say.”
“Pertinent?” She gave him a scornful look. “I don’t even know what you mean by that, Mr. Lewton.”
Harry said nothing, but kept on looking at her with those bright, gentle eyes of his that went so poorly with the rest of his heavy-jawed, broken-nosed, pock-marked face. Half of Ali wanted to make a quick getaway. The other half of her was already in his pocket. I should at least find out what he wants, she reasoned. If he has suspicions, I would be better off knowing what they are.
Across the room, Jamie’s monitor showed all vital signs normal. “All right, consider me your unofficial detainee for the next half hour.” She got up to leave, but then stopped. “Wait! One thing before we go,” she said.
Ali opened the bottom drawer of the desk behind the nursing station and took out an oddly-shaped object wrapped in silver paper. “On Your Special Day!” was printed all over it in red letters, enclosed by decals of white and blue balloons. Inside was a kid’s-sized baseball glove she had bought as a gift for Jamie. It had been autographed by his favorite baseball player, a young center fielder named Chick Suarez, whom Ali had cornered for that purpose at a fundraiser for Lou Gehrig’s disease at the Palmer House. The “special day,” of course, was to have been the day SIPNI started working. But now SIPNI didn’t seem so important. Jamie’s very life was at stake. Ali felt an urgent need to give the glove to Jamie, in his darkest hour, as though it were a talisman that could lend him strength.
She tore off the wrapper and went to Jamie’s bedside. With Harry looking on, she placed the golden-tan glove on Jamie’s left hand, guiding his tiny limp fingers into the slots. As she did so, she read aloud the short line Chick Suarez had written on the back, just above the wrist strap. “Swing for the fences, kid!” it said.
“Swing, Jamie,” she whispered again, her eyes wet with tears. Then she bent over and kissed him on the forehead.
* * *
Eat Street was a soup and sandwich shop just off the main lobby, part of a local chain that catered equally to the sleek and slim and to convalescents. The lunch rush was already over. Ali selected a Diet Coke and a mandarin sesame chicken salad from off the refrigerator shelf, while Harry ordered a roast beef sandwich with Caesar dressing from the sandwich bar. After Harry paid, they moved to a small wrought-iron table in the back. It was the best place for a quiet talk.
Ali watched Harry bite a chunk out of his sandwich and chase it with a swig of coffee. He spoke with food still in his mouth. “So how is your patient making out—that blind kid?”
Ali understood the way Harry ate. She herself squirted a packet of dressing on her salad, and attacked it with the same ferocity as Harry. Both of them were used to speed lunches—lunches that could be interrupted at any moment by an urgent page.
“Not as well as we had hoped. That’s why I need to get back to him as soon as I can.”
“I understand.”
Ali waited to see if Harry would say more. She was annoyed when he simply went on eating. “So what is this ‘pertinent thing’ you wanted to discuss?”
“Straight down to business, huh?”
“I don’t have time for chitchat. Besides Jamie Winslow, I have six patients to round on in the neuro ward, and an article to proof for Nature Medicine, due tomorrow. Plus, if there’s a subarachnoid hemorrhage or a trauma case, I could get called in without warning—America Today or no America Today.”
“Sorry.”
“For what? It’s my life and I like it.”
“Right. Of course. Dedication. The needs of the sick and the dying.”
“Are you patronizing me?”
“No. I admire you—you and all those like you. I just can’t quite figure what you get out of it. I mean, I know why I took to the security business. I like to be in control. In my office I have a status board with a hundred green lights shining on it. I’m not a happy man unless I see every last one of those little green lights. If a red one turns up, it gets personal. My wits, my reflexes, my training, I’ll throw it all against anything that dares to challenge my control. And when I come out on top, when that little light turns green again, I feel like the world’s got some meaning, at least for a little while.”
“What if you don’t come out on top?”
Harry smiled sheepishly. “Let’s not go there,” he said, rubbing his forehead with his thumb. “So, tell me, why medicine?”
“Well, a doctor is … I can only speak for myself. I’m fascinated by the science of it. To study medicine is to study the nature of mankind—my own nature, if you will. If death and suffering are the ultimate questions we all have to face, then medicine is where we face them most lucidly.”
She had given him her official answer, the same answer she had given Kathleen Brown and the Department of Neurosurgery and the admissions committee of McGill Medical School and everyone else who had ever asked her why she had wanted to become a doctor. She did not tell him about the little girl Aliyah, who had watched her distant and godlike father light up with compassion whenever he saw his patients in the little office beneath their apartment on Steinway Street. In medicine, she discovered, there was no place for condemnation or refusal. All who knocked were admitted. It was wonderful to her that there was a place in the world where nothing mattered except to help those who were anxious and sick. She loved her father’s patients. Sitting on the concrete stoop, she would greet each one by name as they came up huffing and puffing, one stair at a time. The pale cloud of mortality around them would break for a moment as they smiled back at her, or thanked her for holding the door. “You are your father’s daughter,” they would say. “You have his warm hands and clever eyes. How God has blessed him with a daughter like you!”
Aliyah knew little of science then. She cared nothing for the mysticism of the little amber bottles with long Latin labels. Not even the stethoscope charmed her, as it had fascinated the other children in the apartment building. She knew only that she had discovered something bright and wonderful, a place where wisdom and kindness were the only things that mattered, a sanctuary from the frightening and implacable world around her. And even in those days—even with the sheltered mind of a seven-year-old—she knew that she must never, ever stray beyond its bounds.
“Your father was a doctor, right?” said Harry, jarring her train of thought. “That must have made it a natural choice for you.”
“Yes,” she sai
d absent-mindedly. But when she had re-thought Harry’s question in hindsight, a flash of bitterness shone through her eyes. “No. No, that’s not true,” she said, her voice hardening. “My becoming a doctor was an act of rebellion. My father had other hopes for me.”
How was young Aliyah to understand that what she prized most in her father—his life of compassion for the hurting and the weak—was off-limits to her? God requires meekness and devotion from you, she was told. It is unseemly for a woman to look upon the nakedness of strangers. Medicine is a dirty business, and woman was made for purity. But Aliyah would not listen. She had found her sanctuary, and she would not give it up. She fasted until she grew thin, until her father worried for her life and agreed at last to pay her way through medical school. In return, she consented to marry the one to whom she had been promised. Her father exacted a solemn vow on that score. But when her training was done, it was too late. She had found strength in self-reliance. She renounced her vow. She bore her father’s rage for doing so. Although the pain in his eyes haunted her for a thousand nights, she could not give in. What was once her sanctuary had become her way of life.
Again, the voice of Harry Lewton broke into her reflection. “Do you mind if I call you Ali?” he said through his mouthful of meat. “Dr. O’Day feels a bit old school.”
“I don’t care what you call me, as long as you come to the point.”
“Very well.” Harry put down his sandwich and suddenly adopted a serious tone. “It’s about your brother.”
“Rahman? I’m not going to talk about him.”
“He’s here in the hospital.”
“What?” She set down her plastic fork and stared at Harry with a half-open mouth.
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