Gravity: A Novel of Medical Suspense

by Tess Gerritsen

  Cutler didn’t respond. His silence confirmed the worst.

  The crew lock pressure was up to fourteen psi. Jack opened the middle hatch and dove into the equipment lock. Frantically he detached his gloves, then doffed his Orlan-M suit and wriggled out of the cooling garment. From the Orlan’s zippered pockets he pulled out various packets containing emergency medications and prefilled syringes of Ranavirus. By now he was shaking with fear, terrified of what he would find inside the station. He swung open the inner hatch.

  And confronted his worst nightmare.

  She was floating in the gloom of Node 1, like a swimmer adrift in a dark sea. Only this swimmer was drowning. Her limbs jerked in rhythmic spasms. Convulsions wracked her spine, and her head snapped forward and back, her hair lashing like a whip. Death throes.

  No, he thought. I won’t let you die. Goddamnit, Emma, you are not going to leave me.

  He grasped her around the waist and began to pull her toward the Russian end of the station. Toward the modules that still had power and light. Her body twitched like a live wire jolted by electric shocks, thrashing in his arms. She was so small, so fragile, yet the strength now coursing through her dying body threatened to overpower his grip on her. Weightlessness was new to him, and he bounced drunkenly off walls and hatchways as he struggled to maneuver them both into the Russian service module.

  “Jack, talk to me,” said Todd. “What’s going on?”

  “I’ve moved her into the RSM—getting her onto the restraint board—”

  “Have you given the virus?”

  “Tying her down first. She’s seizing—” He fastened the Velcro straps over her chest and hips, anchoring her torso to the medical restraint board. Her head slammed backward, her eyes rolling up into the orbits. The sclerae were a brilliant and horrifying red. Give her the virus. Do it now.

  A tourniquet was looped around the restraint-board frame. He whipped it free and tied it around her thrashing arm. It took all his strength to forcibly extend her elbow, to expose the antecubital vein. With his teeth he uncapped the syringe of Ranavirus. Stabbing the needle into her arm, he squeezed the plunger.

  “It’s in!” he said. “The whole syringe!”

  “What’s she doing?”

  “She’s still seizing!”

  “There’s IV Dilantin in the med kit.”

  “I see it. I’m starting an IV!” The tourniquet floated by, a startling reminder that in weightlessness, what was not tied down would quickly drift out of reach. He snatched it from midair and reached, once again, for Emma’s arm.

  A moment later he reported, “Dilantin’s going in! IV’s running wide open.”

  “Any change?”

  Jack stared at his wife, silently demanding, Come on, Emma. Don’t die on me.

  Slowly her spine relaxed. Her neck went limp and her head stopped battering the board. Her eyes rolled forward, and he could see her irises now, two dark pools ringed by bloodred sclerae. At his first glimpse of her pupils, a moan rose in his throat.

  Her left pupil was fully dilated. Black and lifeless.

  He was too late. She was dying.

  He cupped her face in his hands, as though by sheer will he could force her to live. But even as he pleaded with her not to leave him, he knew that she would not be saved by mere touch or prayer. Death was an organic process. Biochemical functions, the movement of ions across cell membranes, slowly ceased. The brain waves flattened. The rhythmic contractions of myocardial cells faded to a quiver. Just wishing it so would not make her live.

  But she was not dead. Not yet.

  “Todd,” he said.

  “I’m here.”

  “What is the terminal event? What happens to the lab animals?”

  “I don’t follow—”

  “You said Ranavirus works, if given early enough in the infection. Which means it must be killing Chimera. So why doesn’t it work when given later?”

  “Too much tissue damage has occurred. There’s internal bleeding—”

  “Bleeding where? What do the autopsies show?”

  “Seventy-five percent of the time, in dogs, the fatal hemorrhage is intracranial. Chimera’s enzymes damage blood vessels on the surface of the cerebral cortex. The vessels rupture, and the bleeding causes a catastrophic rise in intracranial pressure. It’s like a massive head injury, Jack. The brain herniates.”

  “What if you stop the bleeding, stop the brain damage? If you get the victims past the acute stage, they might live long enough for Ranavirus to work.”

  “Possibly.”

  Jack stared down at Emma’s dilated left pupil. A terrible memory flashed into his head: Debbie Haning, unconscious on a hospital gurney. He had failed Debbie. He had waited too long to take action, and because of his indecision, he had lost her.

  I will not lose you.

  He said, “Todd, she’s blown her left pupil. She needs burr holes.”

  “What? You’re working blind. Without X-ray—”

  “It’s the only chance she has! I need a drill. Tell me where the work tools are kept!”

  “Stand by.” Seconds later, Todd came back on comm. “We’re not sure where the Russians stow their kit. But NASA’s are in Node One, in the storage rack. Check the labels on the Nomex bags. The contents are specified.”

  Jack shot out of the service module, once again colliding with walls and hatchways as he clumsily barreled his way into Node 1. His hands were shaking as he opened the storage rack. He pulled out three Nomex bags before he found the one labeled “Power drill/bits/adapters.” He grabbed a second bag containing screwdrivers and a hammer, and shot back out of the node. He’d been away from her for only a moment, yet the fear that he would return to find her dead sent him flying through Zarya and back into the service module.

  She was still breathing. Still alive.

  He anchored the Nomex bags to the table and removed the power tool. It was meant for space station repair and construction, not neurosurgery. Now that he actually held the drill in his hand and considered what he was about to do, panic seized him. He was operating in unsterile conditions, with a tool meant for steel bolts, not flesh and bone. He looked at Emma, lying flaccid on the table, and thought of what lay beneath that cranial vault, thought of her gray matter, where a lifetime of memories and dreams and emotions were stored. Everything that made her uniquely Emma. All of it dying now.

  He reached into the medical kit and took scissors and a shaving razor. Grasping a handful of her hair, he began to snip it away, then shaved the stubble, clearing an incision site over her left temporal bone. Your beautiful hair. I have always loved your hair. I have always loved you.

  The rest of her hair he bound up and tucked out of the way, so it would not contaminate the site. With a strip of adhesive tape, he restrained her head to the board. Moving more quickly now, he prepared his tools. The suction catheter. The scalpel. The gauze. He swished the drill bits in disinfectant, then wiped them off with alcohol.

  He pulled on sterile gloves and picked up the scalpel.

  His skin was clammy inside the latex gloves as he made his incision. Blood oozed from the scalp, welling into a gently expanding globule. He dabbed it with gauze and sliced deeper, until his blade scraped bone.

  To breach the skull is to expose the brain to a hostile universe of microbial invaders. Yet the human body is resilient; it can survive the most brutal of insults. He kept reminding himself of this as he tapped a nick into the temporal bone, as he positioned the tip of the drill bit. The ancient Egyptians and the Incas had successfully performed skull trephinations, opening holes in the cranium with only the crudest of tools and no thought of sterile technique. It could be done.

  His hands were steady, his concentration fierce as he drilled into the bone. A few millimeters too deep, and he could hit brain matter. A thousand precious memories would be destroyed in a second. Or a nick of the middle meningeal artery, and he could unleash an unstoppable fountain of blood. He kept pausing to take a breath, to pr
obe the depth of the hole. Go slow. Go slow.

  Suddenly he felt the last filigree of bone give way, and the drill broke through. Heart slamming in his throat, he gently withdrew the bit.

  A bubble of blood immediately began to form, slowly ballooning out from the breach. It was dark red—venous. He gave a sigh of relief. Not arterial. Even now the pressure on Emma’s brain was slowly easing, the intracranial bleed escaping through this new opening. He suctioned the bubble, then used gauze to absorb the continuing ooze as he drilled the next hole, and the next, punching a one-inch-diameter ring of perforations in the skull. By the time the last hole was drilled, and the circle was complete, his hands were cramping, his face beaded with sweat. He could not pause to rest; every second counted.

  He reached for a screwdriver and ball peen hammer.

  Let this work. Let this save her.

  Using the screwdriver as a chisel, he gently dug the tip into the skull. Then, teeth gritted, he pried off the circular cap of bone.

  Blood billowed out. The larger opening at last allowed it to escape, and it gradually spilled out of the cranium.

  So did something else. Eggs. A clump of them gushed out and floated, quivering, into the air. He caught them with the suction catheter, trapping them in the vacuum jar. Throughout history, mankind’s most dangerous enemies have been the smallest life-forms. Viruses. Bacteria. Parasites. And now you, thought Jack, staring into the jar. But we can defeat you.

  The blood was barely oozing out the cranial hole. With that initial gush, the pressure on her brain had been relieved.

  He looked at Emma’s left eye. The pupil was still dilated. But when he shone a light into it, he thought—or was he imagining it?—that the edges quivered just the slightest bit, like black water rippling toward the center.

  You will live, he thought.

  He dressed the wound with gauze and started a new IV infusion containing steroids and phenobarbital to temporarily deepen her coma and protect her brain from further damage. He attached EKG leads to her chest. Only after all these tasks had been done did he finally tie a tourniquet around his own arm and inject himself with a dose of Ranavirus. It would either kill them both or save them both. He would know soon enough.

  On the EKG monitor, Emma’s heart traced a steady sinus rhythm. He took her hand in his, and waited for a sign.

  August 27

  Gordon Obie walked into Special Vehicle Operations and gazed around the room at the men and women working at their consoles. On the front screen, the space station traced its sinuous path across the global map. At this moment, in the deserts of Algeria, villagers who chanced to glance up at the night sky would marvel at the strange star, brilliant as Venus, soaring across the heavens. A star unique in all the firmament because it was created not by an all-powerful god, nor by any force of nature, but by the fragile hand of man.

  And in this room, halfway around the world from that Algerian desert, were the guardians of that star.

  Flight Director Woody Ellis turned and greeted Gordon with a sad nod. “No word. It’s been silent up there.”

  “How long since the last transmission?”

  “Jack signed off five hours ago to get some sleep. It’s been almost three days since he got much rest. We’re trying not to disturb him.”

  Three days, and still no change in Emma’s status. Gordon sighed and headed along the back row to the flight surgeon’s console. Todd Cutler, unshaven and haggard, was watching Emma’s biotelemetry readings on his monitor. And when had Todd last slept? Gordon wondered. Everyone looked exhausted, but no one was ready to admit defeat.

  “She’s still hanging in there,” Todd said softly. “We’ve withdrawn the phenobarb.”

  “But she hasn’t come out of the coma?”

  “No.” Sighing, Todd slumped back and pinched the bridge of his nose. “I don’t know what else to do. I’ve never dealt with this before. Neurosurgery in space.”

  It was a phrase many of them had uttered over the last few weeks. I’ve never dealt with this before. This is new. This is something we’ve never seen. Yet wasn’t that the essence of exploration? That no crisis could be predicted, that every new problem required its own solution. That every triumph was built on sacrifice.

  And there had been triumphs, even in the midst of all this tragedy. Apogee II had landed safely in the Arizona desert, and Casper Mulholland was now negotiating his company’s first contract with the Air Force. Jack was still healthy, even three days after being aboard ISS—an indication that Ranavirus was both a cure and a preventive against Chimera. And the very fact that Emma was alive counted as a triumph as well.

  Though perhaps only a temporary one.

  Gordon felt a profound sense of sadness as he watched her EKG blip across the screen. How long can the heart go on beating when the brain is gone? he wondered. How long can a body survive a coma? To watch this slow fading away of a once-vibrant woman was more painful than to witness her sudden and catastrophic death.

  Suddenly he sat up straight, his gaze frozen on the monitor. “Todd,” he said. “What’s happening to her?”

  “What?”

  “There’s something wrong with her heart.”

  Todd raised his head and stared at the tracing shuddering across the monitor. “No,” he said, and reached for the comm switch. “That’s not her heart.”

  The high whine of the monitor alarm sliced through Jack’s twilight sleep, and he awakened with a start. Years of medical training, of countless nights spent in on-call rooms, had taught him to surface fully alert from the deepest sleep, and the instant he opened his eyes he knew where he was. He knew something was wrong.

  He turned toward the sound of the alarm and was briefly disoriented by his upside-down view. Emma appeared to be suspended facedown from the ceiling. One of her three EKG leads floated loose, like a strand of sea grass drifting underwater. He turned a hundred eighty degrees, and everything righted itself.

  He reattached her EKG lead. His own heart was racing as he watched the monitor, afraid of what he would see. To his relief, a normal rhythm blipped across the screen.

  And then—something else. A shuddering of the line. Movement.

  He looked down at Emma. And saw that her eyes were open.

  “ISS is not responding,” said Capcom.

  “Keep trying. We need him on comm now!” snapped Todd.

  Gordon stared at the biotelemetry readings, not understanding any of it, and fearing the worst. The EKG skittered up and down, then suddenly went flat. No, he thought. We’ve lost her!

  “It’s just a disconnect,” said Todd. “The lead’s fallen off. She may be seizing.”

  “Still no response from ISS,” said Capcom.

  “What the hell is going on up there?”

  “Look!” said Gordon.

  Both men froze as a blip appeared on the screen. It was followed by another and another.

  “Surgeon, I have ISS,” Capcom announced. “Requesting immediate consultation.”

  Todd shot forward in his chair. “Ground Control, close the loop. Go ahead, Jack.”

  It was a private conversation; no one but Todd could hear what Jack was saying. In the sudden hush, everyone in the room turned to look at the surgeon’s console. Even Gordon, seated right beside him, could not read Todd’s expression. Todd was hunched forward, both hands cupping his headset, as though to shut out any distractions.

  Then he said, “Hold on, Jack. There are a lot of folks down here waiting to hear this. Let’s tell them the news.” Todd turned to Flight Director Ellis and gave him a triumphant thumbs-up. “Watson’s awake! She’s talking!”

  What happened next would remain forever etched in Gordon Obie’s memory. He heard voices swell, cresting into noisy cheers. He felt Todd slap him on the back, hard. Liz Gianni gave a rebel whoop. And Woody Ellis fell into his chair with a look of disbelief and joy.

  But what Gordon would remember most of all was his own reaction. He looked around the room and suddenly found
his throat was aching and his eyes were blurred. In all his years at NASA, no one had ever seen Gordon Obie cry. They were damn well not going to see it now.

  They were still cheering as he rose from his chair and walked, unnoticed, out of the room.

  Five Months Later

  Panama City, Florida

  The squeal of hinges and the clank of metal echoed in the vast Navy hangar as the door to the hyperbaric chamber at last swung open. Jared Profitt watched as the two Navy physicians stepped out first, both of them taking in deep breaths as they emerged. They had spent over a month confined to that claustrophic space, and they seemed a little dazed by their sudden transition into freedom. They turned to assist the last two occupants out of the chamber.

  Emma Watson and Jack McCallum stepped out. They both focused on Jared Profitt, crossing toward them.

  “Welcome back to the world, Dr. Watson,” he said, and held out his hand in greeting.

  She hesitated, then shook it. She looked far thinner than her photographs. More fragile. Four months quarantined in space, followed by five weeks in the hyperbaric chamber, had taken its toll. She had lost muscle mass, and her eyes seemed huge and darkly luminous in that pale face. The hair growing back on her shaved scalp was silver, a startling contrast against the rest of her brown mane.

  Profitt looked at the two Navy doctors. “Could you leave us alone, please?” He waited until their footsteps faded away.

  Then he asked Emma, “Are you feeling well?”

  “Well enough,” she said. “They tell me I’m free of disease.”

  “None that can be detected,” he corrected her. This was an important distinction. Though they had demonstrated that Ranavirus did indeed eradicate Chimera in lab animals, they could not be certain of Emma’s long-term prognosis. The best they could say was that there was no evidence of Chimera in her body. From the moment she’d landed aboard Endeavour, she’d been subjected to repeated blood tests, X rays, and biopsies. Though all were negative, USAMRIID had insisted she remain in the hyperbaric chamber while the tests continued. Two weeks ago, the chamber pressure had been dropped to a normal one atmosphere. She had remained healthy.