by James Hayman
‘You said on one level. What’s the other level?’
‘The other level is spiritual. Ancient people believed the heart was the seat of the soul. Some of us still do. When I do remove a heart, sometimes I hold it in my hand for a minute or two knowing it will give new life to a dying patient. An extraordinary feeling. Today, though the legal definition of death is death of the brain, some people still believe the soul resides, at least partly, in the heart.’
‘Are you one of them?’
Spencer smiled. ‘That, Detective, is my secret.’
‘You’ll be doing a transplant tonight?’
‘Yes. I’m waiting for a heart to be harvested in a hospital in New Hampshire sometime this evening. When it gets here, I’ll be putting it into the body of a forty-five-year-old high school teacher with a wife and two children. Without the transplant, he’d be dead before the end of the year.’
‘Do you think Katie Dubois might have been killed to harvest her heart for a transplant?’
Spencer looked up. ‘You mean as part of some sort of black market in organs?’
‘Yes.’
‘The answer is no.’
‘Why not?’
‘Couldn’t be done.’
‘You said yourself removing a heart wasn’t that difficult.’
‘It’s not. Any reasonably well-trained surgeon or pathologist can do it easily. Harvesting the heart isn’t the problem.’
‘So what is the problem?’
‘There are a lot of problems. For starters, there isn’t a transplant facility anywhere in this country that would accept a harvested heart without knowing precisely where it came from and under what circumstances the donor died, or without the participation of an organization called the United Network for Organ Sharing, which works through various regional OPOs — organ procurement organizations.’
‘That’s where you get your harvested hearts?’
Spencer seemed relaxed, on his own turf. ‘That’s where we have to get them. No choice. The OPOs have a monopoly. There are a couple of dozen of them in the United States. They divvy up the country geographically. Cumberland is the only hospital in Maine doing heart transplants, and all our hearts come through the New England Organ Bank in Newton, Mass.’
‘How does it work?’
‘When a heart becomes available, let’s say somebody is injured in an auto accident, they’re taken to the nearest hospital, which is probably not a transplant center. Then a lot of ifs come into play. If the patient dies and if the heart is healthy. Or if the patient is brain dead and if the heart is healthy. If the hospital’s trauma team can get permission from the victim’s family to harvest the organs. If all those ifs fall into place, the hospital informs the New England Organ Bank and prepares to harvest all usable organs, including the heart.’
‘Who decides who gets the heart?’
‘On any given day, the New England Organ Bank has a backlog of approved transplant patients waiting for hearts or, in some cases, for a heart-lung combination. Those who’d die first are at the top of the list. Geography is also a consideration. You don’t want the heart traveling any farther than it has to. Time in transit is an enemy to a successful transplant. When that’s all sorted out, the heart’s offered to the highest-priority patient with the right blood type and compatible tissue located in the nearest transplant center. Right now, today, there are over twenty-five hundred very sick people in the United States waiting for hearts. Many if not most of them will die waiting.’
‘An ideal situation for a black market, wouldn’t you say?’
‘For the sellers, sure.’
‘Also for the buyers,’ said McCabe. ‘You just said yourself a lot of people die waiting. Wouldn’t a few of them be willing to pay a substantial amount for a chance to jump the queue?’
Spencer paused for a minute, studying McCabe. ‘I’m sure they would,’ he said in a considered voice, ‘but who’s going to perform the transplant, and where? Any recognized transplant center would be crazy to even think about it. So would a qualified surgeon. The operation can’t be done by a surgeon acting alone, no matter how skilled or experienced, and it can’t be done on a kitchen table. When I transplant a heart, there are ten to twelve specialized people in the OR. All critical to the procedure. Plus a lot of sophisticated equipment. Most important is a heart-lung machine and a perfusionist to run it. The heart-lung machine circulates and oxygenates the patient’s blood and keeps him or her alive between the time the sick heart is removed and the healthy heart goes in and begins beating.’
‘What else is required?’
‘What else?’ Spencer shrugged. ‘A diagnostic lab to perform pre-op and post-op tests. A well-stocked blood bank. A facility for postoperative recovery and one-on-one care for at least a few days. You need an array of monitors. You need someone to prescribe and administer antirejection drugs and to watch the patient for signs of infection due to a compromised immune system. You need to be able to follow a fairly rigid postoperative protocol. I just don’t see how some kind of rogue surgeon could put all that together on his own.’
‘How long is a living heart viable after it’s harvested?’
‘Not long. Four or five hours. Our heart in New Hampshire will be placed in an iced saline solution in an ordinary picnic cooler, put on a helicopter, and flown directly here. While that’s being done, we’ll remove our patient’s diseased heart and attach him to the heart-lung machine until he receives his new heart. It’s all very tightly coordinated.’
Four or five hours. Terri Mirabito estimated Katie’s time of death as forty-eight to seventy-two hours before Lacey found her in the scrap yard. Since her body was found around 8:00 P.M. Friday, a transplant would have to have taken place sometime between 8:00 P.M. Tuesday and 8:00 P.M. Wednesday. Twenty-four hours. A big window.
‘How long does a transplant operation take?’
‘Depends how complicated. Anywhere from four hours to a whole day.’
McCabe resisted the temptation to ask Spencer where he was between Tuesday night and Wednesday night. Or Thursday while the body was being dumped. He had no evidence whatsoever that Katie Dubois’s murder was anything other than a random attack by a sexual sadist. McCabe found Spencer’s manner annoyingly arrogant but he had nothing aside from the fact that he was a cardiac surgeon to implicate him one way or the other.
‘How many other surgeons are on staff here at Cumberland? How many other cardiac surgeons?’
‘There are twelve of us in the cardiac unit. Another hundred or so in other specialties or practicing general surgery. I’m not sure of the exact number.’
‘How many do transplants?’
‘Myself and two others. James Puccio and Walter Codman.’
‘Could you get me a list of the other surgeons’ names and contact info? Or shall I get that from a hospital administrator?’
‘Detective, I seriously doubt any surgeon on the staff of this hospital is leading a double life as a sadistic killer of teenaged girls. We’re pretty damned careful about who we bring on board.’
‘I appreciate the sentiment, Doctor, but the evidence suggests we’re looking for a surgeon, and this is one of the places surgeons work. Especially surgeons with an interest in the heart. I’ll also be checking with other hospitals.’
Spencer pursed his lips. ‘Very well,’ he said after a moment. ‘I’ll have my assistant get you a list of the names.’
‘Thank you. I’d also like bios and resumes.’
‘Sorry. I’ll give you names, but that’s it. No CVs or other personal information. There are serious privacy issues involved. If you want to know more, you’ll have to talk to each of the doctors individually.’
As Spencer spoke, an image flashed in McCabe’s mind of Lucinda Cassidy, strapped to an operating table, Philip Spencer leaning over her, ready to cut. ‘Dr. Spencer, time is critical here,’ he said. ‘The more we spend chatting with your staff, the colder the trail will get. It would save us a lot of time i
f you would help.’
‘Sorry. No.’
‘I can get a court order, if I have to.’ McCabe wondered if the doctor knew he was bluffing. Getting a court order from any judge to go rummaging through the personal backgrounds of more than a hundred respected doctors might be a tall order.
‘Then that’s what you’ll have to do. I’m not giving you access. You can always try HR, but I don’t think you’ll have any better luck there.’
He thought about the murder of Elyse Andersen. ‘Any of your surgeons move here from Florida in the last couple of years? Orlando maybe?’
‘You’re starting to annoy me, Detective.’
Spencer’s patience was wearing thin. McCabe decided to drop the issue, at least for now, and try another tack. He glanced again at the Denali picture and again was struck by Spencer’s expression. What was it?
‘I see you’re a mountain climber,’ he said.
‘I’ve done some climbing, yes. Denali, as you can see. Logan in Canada, El Pico de Orizaba in Mexico, Katahdin here in Maine.’
Was Spencer relieved to be changing the subject? McCabe wasn’t sure. ‘Those other guys are friends of yours?’
‘Old friends. We all went to medical school together. We did residencies together. All but one in cardiac surgery, then transplant surgery. At the time, we called ourselves, a little arrogantly I suppose, the Asclepius Society.’
‘Asclepius?’
‘Yes. After the Greek god of healing. Asclepius was so skilled a physician he could actually bring the dead back to life. That’s what we thought we would be doing as transplant surgeons. Bringing the dead back to life.’
McCabe remembered the story from classics class at St. Barnabas. Instead of being pleased with the healer, Zeus became so angry with Asclepius for co-opting the ability to bestow immortality that he slew him on the spot. Seared him with a lightning bolt, like an ancient Tony Soprano.
‘How about you?’ asked Spencer.
‘How about me what?’
‘Are you a climber?’
McCabe thought back to his muddy descent down the slope of the Western Prom. ‘No. I’m definitely not a climber,’ he said. ‘It’s not anything I’ve ever thought about doing.’
‘Maybe you should.’
‘I can’t imagine why.’
‘Well, I could give you a lot of rigmarole about healthful exercise, but I’ve always thought the best answer to why anyone climbs mountains was George Mallory’s. Mallory was a British climber who tried an ascent of Everest back in 1924. He wanted to be the first man to reach the summit. When people asked him why he was determined to make a climb most considered impossible, and some thought suicidal, his answer was “Because it’s there.”’
‘That’s why you climb? Because it’s there?’
‘That’s why any serious climber climbs. Climbing is physically demanding. It can be dangerous. It can’t be called fun in any conventional sense of the word. It forces me to push myself further than I ever thought I could. Test myself. Find out how good I am. To me, and others like me, pushing the limits of our skill is what makes life worth living. It’s always exhilarating. Either hanging from a precipice twenty thousand feet up or cutting open a human being and replacing a heart in an operating room. That sense of exhilaration is what led me into transplant surgery.’
The word ‘risk-taker’ popped unbidden into McCabe’s mind, and he wondered again where Spencer was at the critical times. ‘I gather Mallory didn’t make it,’ he said. ‘Edmund Hillary and Tenzing Norgay were the first to climb Everest.’
‘Yes. Thirty years later. In 1953. A New Zealand bee-keeper and a Nepalese Sherpa. Mallory tried and died in the attempt. The equipment available to him in 1924 wasn’t up to the task. Everest is easier today because of modern equipment. Not easy, but easier. I’m curious. Isn’t there anything you do to test your own limits? To see if you can? Because it’s there?’
McCabe shrugged. ‘I chase murderers. Like Everest, they’re there — and catching them can be challenging.’
Spencer smiled. ‘You’re joking, but I’m serious. You know, I’ll be going up to Acadia in a few weeks for a training climb up the Precipice. It’s a fairly easy climb, but it does have a few tricky patches. Short, steep verticals that can be tough for a beginner. Would you like to give it a try?’
McCabe was surprised by the invitation, wondered why it was offered. ‘I don’t think so.’
‘Why not? You look reasonably fit. I know you don’t lack courage. Tom Shockley told me you ran into the Twin Towers and saved someone’s life on September 11.’
‘Tom Shockley’s got a big mouth.’ McCabe wasn’t surprised Spencer knew Shockley. Portland was a small town. He supposed he shouldn’t be surprised, either, by Shockley’s indiscretion. It was the nature of the beast. ‘Anyway, it wasn’t something I planned. Like an ascent of Everest. Or Denali. I happened to be in a meeting at police headquarters on Center Street that morning. It’s about a five-minute drive from the Towers. When the first plane hit, we all rushed over to see if we could help.’
‘But you ran into the building?’
‘Only because that’s where help was needed. Look, Dr. Spencer, I’m a cop. What I did a lot of other cops did, too. I was just luckier than some. I made it out alive. It wasn’t fun. Or challenging in the way you mean. It’s also personal, and I have to tell you I don’t appreciate Shockley talking about it. To you or anyone else.’
‘How does he know about it?’
‘He didn’t hear it from me.’
‘Interesting.’
‘If you say so. Did Shockley say anything else?’
‘Just that you were a top New York homicide cop who’d gone through a nasty divorce. That you came to Portland because you wanted a safer, more wholesome environment to bring up your daughter.’
Spencer’s beeper went off. He glanced at the screen. ‘Detective, I’m afraid I have to run out on you. They’ve started harvesting my heart.’ As he stood up he added, ‘I’ll be happy to read Dr. Mirabito’s autopsy report and talk to her about whether the wounds on the body were consistent with a harvesting procedure. From your description I suspect they were. As to whether or not a black market in hearts for transplant is even remotely possible, and I don’t think it is, you might want to talk to our transplant co-ordinator here at Cumberland. She can tell you far more about the logistics than I ever could.’
Spencer put his hand on McCabe’s elbow and led him toward the door. They passed the Denali photo. Looking at it close up, McCabe was struck even more than before by something in Spencer’s expression, something in the attitude. He still wasn’t sure what.
‘I’ve enjoyed meeting you, Detective. Good luck in catching whoever it was who cut up that girl. Please let me know if there’s any other way I can help.’
McCabe interrupted Spencer’s dismissal. ‘Just one last question,’ he said.
‘Okay, but make it quick.’ Spencer headed toward the elevator bank.
McCabe followed. ‘You know that Denali picture? Who are the other three guys?’
‘I told you, old friends from medical school. Why do you want to know?’
‘Are they all transplant surgeons?’
‘So that’s it. Listen, I told you this murder was not about heart transplants.’ Spencer pushed the down button harder than he need have.
‘But those men are transplant surgeons, aren’t they?’
‘Yes, two are, not that it’s any of your business.’
‘Not all three?’
‘One’s dead.’
The elevator arrived. McCabe followed Spencer in. Spencer pressed five for himself and the lobby for McCabe. ‘What are the names of the two who are alive?’
‘Oh, for God’s sake, this is ridiculous.’
‘Humor me.’
The doors opened at five and Spencer stepped out. McCabe followed. Spencer stopped and turned to face him. ‘You’re not going any farther.’
‘What are their names? I can
find out on my own. It’ll just take longer.’
Spencer didn’t say anything for a minute. He just stared at McCabe with distaste, as if he had eaten something unpleasant. ‘The man on the left, next to me, is DeWitt Holland. He’s at Brigham in Boston. The one on the far right is Matthew Wilcox, who’s at UNC in Chapel Hill.’
‘Who’s the dead guy? The one you’re looking at in the picture?’
‘His name was Lucas Kane.’ Spencer’s attitude softened. ‘A tragic, tragic loss. In some ways Lucas was the most talented of us all.’
‘How did Kane die?’
‘Lucas was brutally murdered about four years ago. Now, if you’ll excuse me.’ Spencer turned his back and walked away.
‘Just one last question, Dr. Spencer,’ McCabe called after him, the image of Peter Falk’s Columbo popping into his mind. ‘Where were you around midnight last Thursday night?’
Spencer turned. ‘At home. In bed.’
‘Your wife was with you?’
‘Yes. We usually share a bed.’
McCabe rode alone to the ground floor. He passed through a swirl of people in the lobby without noticing them. He left the building and headed toward the Bird. A gaggle of smokers, mostly hospital workers, stood clustered in the corner of the parking lot sucking on their weeds. McCabe was tempted to see if he could bum a smoke from one of them. He’d been a two-pack-a-day smoker for years, and burning tobacco still smelled good to him. He only broke the habit after Casey was born.
10
Saturday. 8:30 P.M.
It was nearly eight thirty when McCabe got back to the condo. He was carting a plastic bag filled with frozen dinners and wondering if Casey had managed to scrounge up anything to eat. Before he could fish the keys out of his pocket, the door swung open. Kyra stood on the other side, a concerned expression on her face.
‘What’s the matter?’ he asked.
‘Your wife called,’ she said.
‘My wife?’
