by Kira Peikoff
Chris and Theo moved aside in the cramped space as he positioned himself next to her left shoulder. “Now,” he said with relish, “for the moment of truth. I want the X101 first.”
“Got it.” Chris handed him a tube of chilled clear fluid that had been stored in a container inside the hole.
Dr. Quinn cradled it in his hands with the affection of a father. It was his life’s work in a vial—the culmination of decades, the reason he had once been celebrated and then viciously destroyed, accused of intellectual theft by a jealous colleague, driven out of research, driven almost to suicide. If not for the Network’s rescue seven years ago, he might very well have been as dead as the corpse before him.
He had designed the drug to exploit the critical time between a person’s death and the death of their brain cells—roughly a four- to eight-hour window, maybe even longer. But by injecting an inhibitor of the calpain enzyme—the signal to brain cells that it was time to die—the process could be slowed down, the window expanded, and the brain temporarily protected from damage. One dose of X101 had bought an additional ten hours of brain cell preservation in animal trials, and now, at last, he was secretly testing it in humans.
He injected a single dose into the woman’s left shoulder. Working quickly, the other men addressed her remaining lines: Chris injected her right shoulder with an icy slurry of water to chill her down rapidly from the inside out. Into her left knee, Theo injected an experimental solution filled with billions of microglobules of fat, each of which contained a dose of oxygen. When released into her body, it would provide a welcome gush to her brain and other organs. In the last line, her right knee, the doctor injected one final drug: coenzyme Q. It was meant to protect mitochondria, the energy-producing part of cells. But the oxygen slurry and the coenzyme Q, both commercially available, were worthless without the X101 to prevent neurons from dying.
Next Theo got to work using the ultrasound machine installed in the ambulance to locate the carotid artery in her neck, then he inserted a thick catheter with two separate tracks, pushing it down near her heart.
“Nice work, Theo,” the doctor commented.
He took over and connected the catheter to a portable machine called an ECMO that pumped blood in a loop outside the body, infusing it with oxygen and cleansing it of carbon dioxide, before cycling it back into the dead woman.
At the same time, Chris inserted a catheter into her groin to start a drip of epinephrine to bring up her blood pressure.
“Hey!” Theo exclaimed, pointing at the cerebral oximeter on her forehead. “It’s already up to forty-five percent.”
“Told you,” the doctor said. “But it’s still got a ways to go. We want it at seventy percent. Now ice her.”
Maneuvering around the stretcher in the tight space, Theo reached into the secret hole and loaded his arms with nearly a dozen artificial ice packs. Together, he and Chris covered her arms, legs, and stomach to cool her down quickly from the outside, in addition to the inside. A thermometer indicated that her current temperature was 95 degrees, but the ice would bring it down to 70. Cold was key: it slowed down decay, snatching back time from the impending claws of irreversible death.
“Excellent, gentlemen,” the doctor announced. “Let’s hit the road.”
Chris hopped out and took his place up front in the driver’s seat. The curtains remained closed, the sirens off. As the ambulance started to roll out of the beach’s parking lot, Dr. Quinn fitted an EEG skullcap over her head to measure her brain waves. The monitor lit up with a low, sustained beep.
Theo’s freckled nose wrinkled. “Shit. She’s still totally flatlined.”
“Because we shut her down,” the doctor said. “We’ve hibernated her.”
The engine whirred and the ambulance sped up. He and Theo settled into straight-backed seats with their knees butting up against the stretcher, holding the black straps dangling from the ceiling. With each turn, the woman’s head lolled from side to side. Her bluish lips were slack around the breathing tube and her puffy eyelids were sealed shut.
Dr. Quinn inched aside a curtain to peek outside. He saw the hospital and morgue pass by, a cluster of old beige buildings as desperately outdated as the medicine that was practiced there.
“What about her organs?” Theo asked. “Isn’t the hospital waiting on the body?”
“Not for long. Chris should be calling it in now—he’ll tell the morgue that we were able to resuscitate her after all, and he’ll tell the hospital that her organs were too damaged for donation. A junkie or something.”
Theo smirked. “Way to honor the dead.”
“The trick is to get her lost in the system. The hospital will think we’re taking her to the morgue and vice versa. Trust me, once organs are out of the question, no one cares about a corpse.”
“What about her family?”
“We don’t know who she is—yet. Let’s hope we get the chance to find out.”
2 hours, 6 minutes dead
The ambulance approached a port where a 440-foot cruise ship was docked. On its side in flowery script were the words Retirement at Sea. It was a stately white vessel with five decks, all but the top one lined with rows of circular windows.
Chris navigated onto a wooden pier parallel to the ship and drove several yards until he reached a certain threshold. As soon as he crossed it, a loading ramp yawned out of the side of the ship and flattened onto the pier. It was lined with seven-foot-tall opaque white panels, ensuring the privacy of all who came and went.
Chris backed up to the ramp and killed the engine. That was their cue: Dr. Quinn and Theo popped open the back door, now shielded from onlookers, and quickly hoisted the dead woman’s stretcher up the ramp and aboard the ship, accompanied by the equipment on poles: the blood-pumping ECMO device, the cerebral oximeter, the still flatlined EEG monitor.
A tall, square-jawed man in his fifties was waiting for them on the deck, where a dozen people were bustling about carrying charts, conferring with one another, striding purposefully in and out of adjacent doors. All were clad in medical scrubs. Though the tall man was the odd one out in black sweatpants and a gray T-shirt, his erect posture lent him an air of dignity. He had the sculpted muscles and wavy dark hair of someone half his age, but the no-nonsense face of a commanding officer. Yet there was a hint of mischief in his blue eyes that softened his intensity. One felt in his presence that nothing could faze him, nor should it.
“Galileo.” Dr. Quinn greeted him with a respectful lift of his chin. “We need an OR.”
“It’s ready and waiting.” Galileo stared at the corpse with the resolve of a doctor confronting the world’s sickest patient. “What’s the prognosis?”
“Iffy. Her lungs are a mess, still no pulse. But the good news is she’s cooled, brain oxygen’s up to seventy percent, and the drugs should have bought us some time.”
“She looks too young to die.” He pressed his lips together, staring at her bone-white face. The black hair plastered to her cheeks made the contrast even starker. “Go. The nurses are already scrubbed in.”
After also scrubbing in at a station of sterile sinks, the doctor and his two techs took the elevator down to the lowest deck. The wide open space that was once a luxurious restaurant with seating for 120 had been entirely transformed. Three plastic partitions separated it into several state-of-the-art operating rooms, each stocked with the surgical tools of a world-class hospital. The only hint of the deck’s past life was a gold, crystal-encrusted chandelier still hanging from the ceiling.
They hurried into OR 1, where two gray-haired intensive-care nurses were gloved, masked, and standing by. Though only their eyes were visible, Dr. Quinn was pleased to recognize Annie and Corinne, the Network’s most experienced gems. They flashed him smiles with their eyes, while Chris and Theo laid the corpse flat on the table. The techs were careful not to disrupt any of the tools tethered to her, including the ice packs keeping her cool and the CPR device that was still delivering compressio
ns to her chest in quick bursts.
Then the two men got out of the way while the others converged around the dead woman in choreographed posts: the doctor standing behind her head, the nurses on either side of him, extending his reach to the various shiny tools on trays nearby.
They responded rapid-fire to his commands, and Dr. Quinn was soon gripping a heavy silver drill with both hands. Steadily he punctured a bolt into the back of the woman’s skull. The noise of grinding through bone always made him wince, though he knew she could feel no pain. A sensor attached to the bolt sat on the surface of her brain to measure intracranial pressure.
“Good to go,” he said. “Next up, a bronchoscope, please.”
The nurses moved with the swiftness and grace of dancers. Within minutes, the doctor had inserted a smaller tube with a camera into her breathing tube, sucked out salt water, washed out her lungs with a sterile solution, and given her a dose of antibiotics.
All along the nurses took turns reading out numbers to keep him informed of her oxygen, carbon dioxide, brain pressure, and blood pressure. It was no simple task to maintain the ideal balance of each number: to maintain the goal of 70 percent brain oxygen, they had to pump it into the bloodstream at 95 percent and no further. Oxygen itself was toxic to cells if too concentrated, and dangerously deficient if not enough. Right now she was at a perfect 70 percent and 40 mmHg of carbon dioxide; they just had to keep her there.
“Okay, now bring her blood pressure up, up, up!” the doctor commanded, lifting his hands. The key was to maintain a higher than usual arterial pressure—90 instead of the usual 65—to pump the blood back into her brain. Careful monitoring of the bolt sensor would ensure that the brain wasn’t getting crushed by the pressure.
Annie was leaning down to check on the bolt when she caught sight of something odd: a bald patch the size of a thumbprint on the woman’s head, near her right ear.
“Did you see this?” she asked the doctor. He shifted his gaze from the blood pressure monitor to the patch and shrugged.
“No, but she’s got more to worry about than a bad hair day right now.”
“But isn’t it—”
Annie was cut off by the sudden angry beeping of a monitor.
“O2’s spiking!” Corinne yelled. The cerebral oximeter was jumping up—80 percent, 85 percent, 87 percent.
Dr. Quinn leaped to the ECMO machine that was pumping oxygen into her blood through the tube in her neck and adjusted the output. When the percentages started dropping back down, he exhaled a breath. He didn’t look away until she was stable again at 70 percent.
“Okay,” he said at last. “Lungs are clean. The numbers look good. You know what to do.”
The nurses removed the ice packs lining her arms, stomach, and legs, as the doctor set the temperature regulator on the ECMO to gradually rewarm her body at a rate of 0.25 degrees Celsius per hour. The thaw out of the cold state was precisely calibrated—if it happened too quickly, intracranial pressure could spike and cause permanent death.
When there was nothing left to do, the doctor gazed down at the intubated, catheterized, machine-addled corpse on the table. It was difficult not to think of her as his patient, even though—by definition—she was still as dead as ever. No heartbeat, no respiration, no brain waves.
He looked up at the nurses with a hopeful smile.
“Now,” he said, “we wait.”
15 hours, 20 minutes dead
“Quinn!” yelled a familiar husky voice into the intercom. It was Annie. Her words blasted through his wall and woke him with a start. It was after 1 A.M. His fitful dream evaporated like vapor as reality hardened around him: he was in his compact box of a room on deck two, gently rocking with the ocean’s waves. Frustration nettled him. Where was his patient? Why was he in bed?
Then he recalled keeping vigil next to her body for nearly twelve hours before falling asleep on the floor. Someone must have moved him here.
He jumped up and crossed the three steps to his intercom. “What did I miss?”
“Come fast. There’s a flicker on the heart monitor.”
He felt a joyous bubble rise in his throat, somewhere between a laugh and a sob. Ten seconds later, he was back by her side in the operating room. Her pulse was erratic, to be sure. A shy beep could be heard at jagged intervals, persisting for several seconds and then disappearing altogether. Her temperature had climbed to 86 degrees Fahrenheit. A pinkish smudge was returning to her ashen cheeks.
“Come on,” he muttered. “Come on.”
Within minutes the flicker became a sustained line and the beep, a steady rhythm.
“Atta girl!” he cried. “Isn’t that the most beautiful music you ever heard?”
Annie stood behind him, her hazel eyes bloodshot and weary. “But she’s still flatlined. What if her brain doesn’t come back?”
“It will. Give her time. I’ll take over. You go to bed.”
For three more hours, he waited. As the rest of the ship slept, he kept an obsessive eye on every number that could be measured. No matter how many times he had gone through this process—she was the twenty-second patient in his clinical trial—he was awestruck witnessing the retreat of death. It was the stuff of the supernatural, the Holy Grail sought across all of time—yet it was real. It was happening in front of him.
Only in the last decade had pioneers in cardiac resuscitation made it possible to revive people hours after they’d drawn their last breath, and now his drug X101 was lengthening that window. So far it had worked every time to limit brain damage and restore patients to their full selves, even up to twenty-four hours after their deaths. He was confident it would work again on this Jane Doe, yet he still felt a desperate yearning bordering on despair with each minute that ticked by.
What would he do if he actually did bring her back to life, but brain-dead? Could he ethically just pull the plug without consent, if he didn’t know her identity or her family? Or was he bound to keep her on life support indefinitely? It was a dilemma he had never faced, but he tortured himself with its plausibility as the night wore on.
At last, when her temperature reached 91 degrees, he saw it: a spasm of electricity on the EEG. He jumped from his chair and stared, captivated, at the monitor. The previously flat line transformed into spiky bursts of peaks and valleys. They stabilized over the next six hours as her temperature rose to 98 degrees. The doctor oversaw every moment, talking to her gently in case she could hear him. She was in a deep coma, but she wasn’t brain-dead. Now she wasn’t dead at all.
1 minute awake
Her eyes opened. They roamed back and forth, squinting under the fluorescent lights. Her face scrunched up as if she were about to cry. Instead she groaned past her breathing tube and thrashed her legs, her heart rate skyrocketing: 132, 140, 147.
A petite young nurse, who was covering the morning shift, cupped a hand over her mouth and gasped. At the bedside, Dr. Quinn clutched the woman’s warm left hand in both of his. He had been awaiting this moment all night.
“You’re okay,” he said softly. “You’re just waking up from a bad accident.”
Her head rolled back and forth. An involuntary moan escaped her.
“I’m going to take out your tube now. This’ll be quick. There we go, see, no problem, easy does it—and it’s out.”
She immediately coughed. “Wa—” she started, then choked and coughed again. Her hand flew to her throat.
“Right here.” The doctor lifted a white paper cup to her lips. He cradled her head and she sipped greedily, spilling much of it down her neck. When he pulled back her paper drape to blot her collarbone dry, he noticed a row of deep purple bruises. How could he not have seen them at first? But then he realized that would have been impossible; they could have shown up only after blood was recirculated through into her body.
“Boy,” he said, “you really got tossed around in those waves.”
“Won’t . . . pay,” she mumbled, her eyes blinking rapidly but failing to focus on a
nything. “Not got. Me no.”
“What’s she saying?” the nurse asked under her breath.
“She’s just confused,” the doctor whispered. “It’s the drugs. Don’t worry—it’s normal at first.”
“Me!” the woman exclaimed with a sudden loopy grin. Her tone was gleeful. “Me! Mama.” Her eyes darted around the room, then closed. In a minute she was asleep again.
The nurse raised her eyebrows. “Imagine what her family must be going through, wherever they are.”
“We’ll get her back to them soon enough.” The doctor stroked his patient’s clammy forehead. “Once her delirium wears off and she’s stable, we’ll give her a mild tranquilizer and transport her to the real hospital. She’ll think she was there the whole time, in a coma, and the staff will conclude that some embarrassing miscommunication caused her to get lost in their system. They’ll do everything to cover it up, but if any investigation is opened, our ally on the Board will shut it down. All that counts is that she’s reunited with her family alive and well. Her death will be nothing but a forgotten footnote in her life.”
48 hours awake
She spent two days in a blur of intravenous feedings, babbling, sleep, and agitation. Once her vitals stabilized, she was moved up to deck three into her own private recovery room, with a porthole that let in abundant sunshine. Its morning rays now bathed her skin in a healthy glow, no signs of her earlier pallor. She was sleeping, but Dr. Quinn knew that when she awoke this time, the effects of the drugs would be over. She’d be herself again—whoever she was.
He grinned at the report in his hand from the recent MRI of her brain: normal. Completely, beautifully normal. The X101 had once again proved its efficacy, in combination with the oxygenated fat globules and the mitochondria-protecting enzymes. Part of him wanted to just call off the clinical trial and make the whole protocol available stat to every hospital in the country, hell, in the world—but he knew it was too risky to blow the Network’s cover over such preliminary results. If they got to five hundred patients and the percentages held, then he and Galileo would have some serious decisions to make. Would the U.S. government forgive their transgressions of illegal human experimentation if the peace offering was a way to reverse death? He liked to think so. But if not...
