The Surgeon by Tess Gerritsen
There was a long silence. Moore felt his own heart pounding as he waited for the answer he hoped for.
Then she said, softly: “No.”
He sank back in his chair. The tension in the room had suddenly collapsed. To this victim, the Surgeon was a stranger, a man without a name, whose reasons for choosing her remained a mystery.
Masking the disappointment in his voice, he said: “Describe him for us, Nina.”
She took a deep breath and closed her eyes, as though to conjure up the memory. “He had . . . he had short hair. Cut very neatly . . .”
“What color?”
“Brown. A light shade of brown.”
Consistent with the strand of hair they’d found in Elena Ortiz’s wound. “So he was Caucasian?” said Moore.
“Yes.”
“Eyes?”
“A pale color. Blue or gray. I was afraid to look straight at them.”
“And the shape of his face? Round, oval?”
“Narrow.” She paused. “Ordinary.”
“Height and weight?”
“It’s hard to—”
“Your best guess.”
She sighed. “Average.”
Average. Ordinary. A monster who looked like any other man.
Moore turned to Frost. “Let’s show her the six-packs.”
Frost handed him the first book of mug shots, called six-packs because there were six photographs per page. Moore set the book on a bedside tray table and wheeled it in front of the patient.
For the next half hour they watched with sinking hopes as she flipped through the books without pausing. No one spoke; there was only the hiss of the oxygen and the sound of the pages being turned. These photos were of known sex offenders, and as Nina turned page after page it seemed to Moore that there was no end to the faces, that this parade of images represented the dark side of every man, the reptilian impulse disguised by a human mask.
He heard a tap on the cubicle window. Looking up, he saw Jane Rizzoli gesturing to him.
He stepped out to speak to her.
“Any ID yet?” she asked.
“We’re not going to get one. He was wearing a surgeon’s mask.”
Rizzoli frowned. “Why a mask?”
“It could be part of his ritual. Part of what turns him on. Playing doctor is his fantasy. He told her he was going to cut out the organ that had been defiled. He knew she was a rape victim. And what did he cut out? He went right for the womb.”
Rizzoli gazed into the cubicle. She said quietly: “I can think of another reason why he wore that mask.”
“Why?”
“He didn’t want her to see his face. He didn’t want her to identify him.”
“But that would mean . . .”
“It’s what I’ve been saying all along.” Rizzoli turned and looked at Moore. “The Surgeon fully intended for Nina Peyton to survive.”
How little we truly see into the human heart, thought Catherine as she studied the X ray of Nina Peyton’s chest. Standing in semidarkness, she gazed at the film clipped to the light box, studying the shadows cast by bones and organs. The rib cage, the trampoline of diaphragm, and resting atop it the heart. Not the seat of the soul, but merely a muscular pump, unendowed with any more mystical purpose than the lungs or the kidneys. Yet even Catherine, so grounded in science, could not look at Nina Peyton’s heart without being moved by its symbolism.
It was the heart of a survivor.
She heard voices in the next room. It was Peter, requesting a patient’s films from the file clerk. A moment later he walked into the reading room and paused when he saw her, standing by the light box.
“You’re still here?” he said.
“So are you.”
“But I’m the one on call tonight. Why don’t you go home?”
Catherine turned back to Nina’s chest X ray. “I want to be sure this patient is stable first.”
He came to stand right beside her, so tall, so imposing, that she had to fight the impulse to step away. He scanned the film.
“Other than some atelectasis, I don’t see much there to worry about.” He focused on the name “Jane Doe” in the corner of the film. “Is this the woman in Bed Twelve? The one with all the cops hanging around?”
“Yes.”
“I see you extubated her.”
“A few hours ago,” she said reluctantly. She had no wish to talk about Nina Peyton, no wish to reveal her personal involvement in the case. But Peter kept asking questions.
“Her blood gases okay?”
“They’re adequate.”
“And she’s otherwise stable?”
“Yes.”
“Then why don’t you go home? I’ll cover for you.”
“I’d like to keep an eye on this patient myself.”
He placed his hand on her shoulder. “Since when did you stop trusting your own partner?”
At once she froze at his touch. He felt it and withdrew his hand.
After a silence, Peter moved away and began hanging his X rays on the box, shoving them briskly into place. He’d brought in an abdominal CT series, and the films took up an entire row of clips. When he had finished hanging them, he stood very still, his eyes hidden by the X ray images reflected in his glasses.
“I’m not the enemy, Catherine,” he said softly, not looking at her but focusing instead on the light box. “I wish I could make you believe that. I keep thinking there’s got to be something I did, something I said, that’s changed things between us.” At last he looked at her. “We used to rely on each other. As partners, at the very least. Hell, the other day, we practically held hands in that man’s chest! And now you won’t even let me cover for one patient. By now, don’t you know me well enough to trust me?”
“There’s no other surgeon I trust more than you.”
“Than what’s going on here? I get to work in the morning, and find out we’ve had a break-in. And you won’t talk to me about it. I ask you about your patient in Bed Twelve, and you won’t talk to me about her, either.”
“The police have asked me not to.”
“The police seem to be running your life these days. Why?”
“I’m not at liberty to discuss it.”
“I’m not just your partner, Catherine. I thought I was your friend.” He took a step toward her. He was a physically imposing man, and his mere approach suddenly made her feel claustrophobic. “I can see you’re scared. You lock yourself in your office. You look like you haven’t slept in days. I can’t stand by and watch this.”
Catherine yanked Nina Peyton’s X ray off the light box and slid it into the envelope. “It has nothing to do with you.”
“Yes, it does, if it affects you.”
Her defensiveness instantly turned to anger. “Let’s get something straight here, Peter. Yes, we work together, and yes, I respect you as a surgeon. I like you as a partner. But we don’t share our lives. And we certainly don’t share our secrets.”
“Why don’t we?” he said softly. “What are you afraid of telling me?”
She stared at him, unnerved by the gentleness of his voice. In that instant, she wanted more than anything to unburden herself, to tell him what had happened to her in Savannah in all its shameful detail. But she knew the consequences of such a confession. She understood that to be raped was to be forever tainted, forever a victim. She could not tolerate pity. Not from Peter, the one man whose respect meant everything to her.
“Catherine?” He reached out.
Through tears she looked at his outstretched hand. And like a drowning woman who chooses the black sea instead of rescue, she did not take it.
Instead she turned and walked out of the room.
twelve
Jane Doe has moved.
I hold a tube of her blood in my hand, and am disappointed that it is cool to the touch. It has been sitting in the phlebotomist’s rack too long, and the body heat this tube once contained has radiated through the glass and dissipated into the air.
I put the tube back in the rack, where it sits with two dozen other tubes, capped with rubber stoppers of blue and purple and red and green, each color signifying a different procedure to be done. The purple tops are for blood counts, the blue tops for clotting tests, the red tops for chemistries and electrolytes. In some of the red-top tubes, the blood has already congealed into columns of dark gelatin. I look through the bundle of lab orders and find the slip for Jane Doe. This morning, Dr. Cordell ordered two tests: a complete blood count and serum electrolytes. I dig deeper into last night’s lab orders, and find the carbon copy of another requisition with Dr. Cordell’s name as ordering physician.
“STAT arterial blood gas, post-extubation. 2 liters oxygen by nasal prongs.”
Nina Peyton has been extubated. She is breathing on her own, taking in air without mechanical assistance, without a tube in her throat.
I sit motionless at my workstation, thinking not of Nina Peyton, but of Catherine Cordell. She thinks she has won this round. She thinks she is Nina Peyton’s savior. It is time to teach her her place. It is time she learned humility.
I pick up the phone and call Hospital Dietary. A woman answers, her speech pressured, the sound of trays clanging in the background. It is near the dinner hour, and she has no time to waste in chitchat.
“This is Five West,” I lie. “I think we may have mixed up the dietary orders on two of our patients. Can you tell me which diet you have listed for Room Five-thirty-eight?”
There is a pause as she taps on her keyboard and calls up the information.
“Clear liquids,” she answers. “Is that correct?”
“Yes, that’s correct. Thank you.” I hang up.
In the newspaper this morning, Nina Peyton was said to remain comatose and in critical condition. This is not true. She is awake.
Catherine Cordell has saved her life, as I knew she would.
A phlebotomist crosses to my station and sets her tray full of blood tubes on the counter. We smile at each other, as we do every day, two friendly coworkers who by default assume the best about each other. She is young, with firm high breasts that bulge like melons against her white uniform, and she has fine, straight teeth. She picks up a new sheaf of lab requisitions, waves, and walks out. I wonder if her blood tastes salty.
The machines hum and gurgle a continuous lullaby.
I go to the computer and call up the patient list for 5 West. There are twenty rooms in that ward, which is arranged in the shape of an H, with the nursing station located in the crossbar of the H. I go down the list of patients, thirty-three in all, scanning their ages and diagnoses. I stop at the twelfth name, in Room 521.
“Mr. Herman Gwadowski, age 69. Attending physician: Dr. Catherine Cordell. Diagnosis: S/P emergency laparotomy for multiple abdominal trauma.”
Room 521 is located in a parallel hallway to Nina Peyton’s. From 521, Nina’s room is not visible.
I click on Mr. Gwadowski’s name and access his lab flowsheet. He has been in the hospital two weeks and his flowsheet goes on for screen after screen. I can picture his arms, the veins a highway of needle punctures and bruises. From his blood sugar levels, I see he is diabetic. His high white blood cell counts indicate he has an infection of some sort. I notice, too, that there are cultures pending from a wound swab of his foot. The diabetes has affected the circulation in his limbs, and the flesh of his legs is starting to necrose. I also see a culture pending on a swab from his central venous line site.
I focus on his electrolytes. His potassium levels have been steadily climbing. 4.5 two weeks ago. 4.8 last week. 5.1 yesterday. He is old and his diabetic kidneys are struggling to excrete the everyday toxins that accumulate in the bloodstream. Toxins such as potassium.
It will not take much to tip him over the edge.
I have never met Mr. Herman Gwadowski—at least, not face-to-face. I go to the rack of blood tubes which have been sitting on the counter and look at the labels. The rack is from 5 East and West, and there are twenty-four tubes in the various slots. I find a red-top tube from Room 521. It is Mr. Gwadowski’s blood.
I pick up the tube and study it as I slowly turn it under the light. It has not clotted, and the fluid within looks dark and brackish, as though the needle that punctured Mr. Gwadowski’s vein has instead hit a stagnant well. I uncap the tube and sniff its contents. I smell the urea of old age, the gamey sweetness of infection. I smell a body that has already begun to decay, even as the brain continues to deny the shell is dying around it.
In this way, I make Mr. Gwadowski’s acquaintance.
It will not be a long friendship.
Angela Robbins was a conscientious nurse, and she was irritated that Herman Gwadowski’s ten o’clock dose of antibiotics had not yet arrived. She went to the 5 West ward clerk and said, “I’m still waiting for Gwadowski’s IV meds. Can you call Pharmacy again?”
“Did you check the Pharmacy cart? It came up at nine.”
“There was nothing on it for Gwadowski. He needs his IV dose of Zosyn right now.”
“Oh. I just remembered.” The clerk rose and crossed to an in box on the other countertop. “An aide from Four West brought it up a little while ago.”
“Four West?”
“The bag was sent to the wrong floor.” The clerk checked the label. “Gwadowski, Five-twenty-one-A.”
“Right,” said Angela, taking the small IV bag. On the way back to the room, she read the label, confirming the patient’s name, the ordering physician, and the dose of Zosyn that had been added to the bag of saline. It all appeared correct. Eighteen years ago, when Angela had started work as a newly minted nurse, an R.N. could simply walk into the ward’s supply room, pick up a bag of IV fluid, and add to it the necessary medications. A few mistakes made by harried nurses, a few highly publicized lawsuits, had changed all that. Now even a simple IV bag of saline with added potassium had to come through the hospital pharmacy. It was another layer of administration, another cog in what was already the complicated machinery of health care, and Angela resented it. It had caused an hour’s delay in this IV bag’s arrival.
She switched Mr. Gwadowski’s IV tubing to the new bag and hung the bag on the pole. Through it all, Mr. Gwadowski lay unmoving. He’d been comatose for two weeks, and already he exuded the smell of death. Angela had been a nurse long enough to recognize that scent, like sour sweat, that was the prelude to the final passing. Whenever she detected it, she would murmur to the other nurses: “This one’s not going to make it.” That’s what she thought now, as she turned up the IV flow rate and checked the patient’s vital signs. This one is not going to make it. Still, she went about her tasks with the same care she gave to every patient.
It was time for the sponge bath. She brought a basin of warm water to the bedside, soaked a washcloth, and started by wiping Mr. Gwadowski’s face. He lay with mouth gaping open, the tongue dry and furrowed. If only they could let him go. If only they could release him from this hell. But the son would not even allow a change in the code status, and so the old man lived on, if you could call this living, his heart continuing to beat in its decaying shell of a body.
She peeled off the patient’s hospital gown and checked the central venous line skin site. The wound looked slightly red, which worried her. They had run out of IV sites on the arms. This was their only IV access now, and Angela was conscientious about keeping the wound clean and the bandage fresh. After the bed bath, she would change the dressing.
She wiped down the torso, running her washcloth across the ridges of rib. She could tell he had never been a muscular man, and what was left now of his chest was merely parchment
She heard footsteps and was not happy to see Mr. Gwadowski’s son come into the room. With a single glance, he put her on the defensive—that’s the sort of man he was, always pointing out mistakes and flaws in others. He frequently did it to his sister. Once Angela heard them arguing and had to stop herself from coming to the sister’s defense. After all, it was not Angela’s place to tell this son what she thought of his bullying. But she need not be overly friendly to him, either. So she merely nodded and continued with the sponge bath.
“How’s he doing?” asked Ivan Gwadowski.
“There’s been no change.” Her voice was cool and businesslike. She wished he would leave, would finish his little ceremony of pretending to care, and let her get on with her work. She was perceptive enough to understand that love was but a minor part of why this son was here. He had taken charge because that’s what he was accustomed to doing, and he wouldn’t relinquish control to anyone. Not even Death.
“Has the doctor been in to see him?”
“Dr. Cordell comes in every morning.”
“What does she say about the fact he’s still in a coma?”
Angela put the washcloth in the basin and straightened to look at him. “I’m not sure what there is to say, Mr. Gwadowski.”
“How long will he be like this?”
“As long as you allow him to be.”
“What does that mean?”
“It would be kinder, don’t you think, to let him go?”
Ivan Gwadowski stared at her. “Yes, it makes everyone’s life easier, doesn’t it? And it frees up another hospital bed.”
“That’s not why I said it.”
“I know how hospitals get paid these days. The patient stays too long, and you eat the costs.”
“I’m only talking about what’s best for your father.”
“What’s best is that this hospital does its job.”
Before she could say anything she regretted, Angela turned and grabbed the washcloth from the basin. Wrung it out with shaking hands. Don’t argue with him. Just do your job. He’s the kind of man who’ll take it all the way to the top.