Code White Part 11

Harry stiffened. "'Routine bomb threat' is an oxymoron. A bomb threat is never routine. The contents of the bag in Endocrinology indicated that whoever left it for us is capable of constructing a real, and very powerful, explosive device."

"Why don't you evacuate?"

"This is a hospital, not an office building. The logistics of evacuation are almost insurmountable. You have a thousand bedridden patients, some of them unconscious or in critical condition. You have surgeries in progress in the operating rooms. You have premature babies in incubators. You can't just pack up and get out. We have evacuation protocols, but they've never been implemented. Not under real-life conditions. Even the best written plan will fall apart once you add the ingredients of risk, fear, and panic. Chaos is inevitable. Chaos in this context means injuries, wreckage-even death."

"I see."

"Plus, there's factor number one: the ransom message specifically said, 'Don't evacuate.' They want to play this out smoothly and quietly."

"Well, you don't have to do what the bomber wants, do you?"

"Actually, we do. As long as they can detonate a bomb in this facility, we can and do have to follow their instructions to the letter. And by 'we,' I mean us and you-now that you've inserted yourself into the equation."

"I'm in the business of reporting events, not keeping them quiet."

"You're in the business of covering human-interest features, if I'm not mistaken. Movie-star weddings, world's ugliest dogs-things like that. This is a little bit out of your normal line."

Kathleen Brown took on a p.r.i.c.kly tone. "I was an investigative reporter in Tulsa before I joined the network."

Harry bit his lip. He had taken a cheap shot and needed to backtrack nimbly. "Okay. You have your job and I have mine. But our interests don't have to be at odds."

"If you play along, I could make you look pretty good."

"That's not what I mean. I don't give a d.a.m.n about anything except protecting this medical center. If you help me to do that, I'll let you and your crew have the run of the hospital. Film whatever you want, as long as you don't get in the way. And that's an exclusive. You're here because ... well, because you're here. But I'm not letting any other news teams in. That gives you a pretty sweet setup."

"What do you want in return?"

"To avoid panic. We've been instructed not to evacuate. The group responsible for this threat has been very specific about that. If you start scaring people, there'll be a stampede out of the hospital-the ugliest you've ever seen. This, as you now know, would be in direct violation of our instructions. I don't want to risk what might happen then."

"So you're asking me to hold back the story."

"For a little while. Until we know for sure what's going on."

"And if I refuse?"

"Then you and your crew can shoot your hearts out from across the street, after I bar you from the premises. I'll have the police set up a three-hundred-yard security perimeter. You'll need a telephoto lens just to see the sign out front."

"All right. But I won't allow any prior review or censoring of my reports."

"Understood."

"And I expect you to keep me informed of any developments. Directly and exclusively. No more canned statements."

"You'll get what you get. All I guarantee is that you'll get it first."

"Okay. I guess I'll have to live with that."

Harry held out his hand. Kathleen Brown hesitated before taking it. But then they shook. Her hand was ice-cold.

Is this what it's like to shake hands with the devil? Harry mused.

After leaving Harry's office, Ali had been too upset to return to the family lounge or to the recovery room. She had learned that the bomb was real, not a rumor or a false alarm. Somewhere among these white-tiled corridors was hidden a weapon so promiscuous in its cruelty that no one was safe from it. She herself could die, instantly and without warning. Even more alarming was the thought that Jamie Winslow could die. She needed to protect him. But how? She understood how to protect him from shock and hemorrhage and electrolyte imbalances, but a bomb? She felt loathing and anger toward the coward who could threaten the life of a helpless boy. She was angry, too, at the FBI. Why had they wasted their time picking on her, instead of finding a way to evacuate the hospital? No one except Harry Lewton had seemed to know how much was at stake.

Harry Lewton ... The thought of that name, and that mash-nosed face with the piercing eyes, troubled her more than anything. I think you do know something, he had said. He had said it a split second before even she herself realized it was true. Yes, she knew that she knew something. But she had no idea what that something was. Did Harry know? Could he read more deeply into her than she could read herself? She felt as though he could, and that thought made her breathe uneasily. All her life she had hid her feelings from others, and it was upsetting to know that there was someone who could see through the veil. She wished she had never met Harry Lewton.

Up and down the Pike she walked, trying to reason her feelings away, but the more she thought, the more angry and fearful she became. Jamie needed her back in Recovery, but she was too upset to go there. She needed something physical to calm herself. As she often did when troubled, she stole away to the small Chapel of All Faiths on the first floor. This softly lit, carpeted room, with an abstract mosaic of colored gla.s.s at one end, was, for all its intended eclecticism, reminiscent of a Christian church. The chapel was empty, as it usually was in the morning, and Ali sat down on the floor with her back to the first row of pews. Holding her spine erect, she closed her eyes and began to breathe consciously, alternating the deep, slow rhythm of deergha shvaasam with the rapid puffing of kapalabhati, or "skull shining."

Within a few minutes, she felt the initial stage of a lightening of her entire body, and a kind of darkness in which nothing existed except her breathing. How rudely jarred was she, then, when she heard her name read on the overhead pager. "Dr. O'Day, please call the Neuro ICU."

She ran to the nearest phone. Dr. Stephen Brower, an intensive care specialist, had a problem. "It's this patient of yours," Brower said. "Winslow. He's unresponsive."

Brower. So they've transferred Jamie from Recovery to the ICU. "That's to be expected," Ali said. "I'm keeping him sedated."

"This is more than sedation. I can't arouse him at all. I just drew an arterial blood gas from him and he didn't even flinch."

The urgency in Brower's voice hit a nerve. Ali felt an impulse to rush to the ICU and do something-anything-to correct the situation. That was unlike her and she knew it. She wasn't reacting clinically. She was reacting to an image of Jamie Winslow lying like a limp, helpless puppet in his bed. This is wrong, she thought. I can't help him like this. I have to be a doctor for him now. And so Ali forced herself to put Jamie the sweet little seven-year-old boy aside, in favor of "Winslow, J., status post AVM resection and neural prosthetic implant." She ran through the most likely problems in her mind: Anesthesia reaction. Jamie had just come out of recovery, and some patients were known to have unique and unpredictable reactions to general anesthesia. But Jamie had undergone anesthesia before with the very same gas c.o.c.ktail, and had experienced no ill effects. A reaction now would be unusual.

Bleeding. Dr. Helvelius had meticulously sealed off every vessel leading to the AVM, and she herself had watched for many minutes, making sure that no bleeding remained. Yet it sometimes happened that a vessel tore open after surgery. Even a tiny arterial bleed could become life-threatening if it began to dig through the soft brain tissue, tearing open more vessels as it went.

Stroke. Stroke was unthinkable for a normal boy of Jamie's age. But the AVM had stolen away so much of the brain's blood supply for so long, that Jamie's brain was unused to the full arterial pressure that now coursed through it. His cerebral blood vessels were abnormally lax, and, in a condition called normal perfusion pressure breakthrough, they could rupture anywhere-even far from the site of surgery.

Brain swelling. This was the complication Ali feared most. Sometimes during surgery the brain was invisibly injured-by lack of oxygen, by contact with the retractors, by electrolyte shifts in the blood, or by factors that were still a mystery to science. Injury to the brain almost always meant swelling, but because the brain was encased in a rigid skull vault, there was no room for it to expand. Instead, there was a dramatic increase in pressure, which often came on suddenly, progressed rapidly, and was difficult to stop once it had started. If not arrested in time, it could crush the vital centers of the medulla oblongata against the base of the skull, or completely shut down blood flow to the brain, leading to immediate death.

Antic.i.p.ating the possibility of this complication, during surgery Ali had placed a small sensor called an intracranial pressure monitor in Jamie's brain, leaving it to protrude through the scalp and a small hole in the skull, like the cap of a spark plug. So the first thing she did was ask Dr. Brower what the pressure reading on the ICP was.

"Fifteen millimeters of mercury," he said. "Upper limit of normal."

"Okay, let's get a noncontrast CT. Stat. I'll head down to Radiology."

Like most of the Department of Radiology, the CT scanning rooms were in the first bas.e.m.e.nt level. Ali got there ahead of Jamie, and helped the technologists and nurses lift him onto the scanner bed when he arrived. She was alarmed by the way he looked. Although his cranial nerve reflexes were intact, he did not respond to his name, and lay limp and quiet, as though he were profoundly drunk.

As the scan got started, Ali waited with the neuroradiologist, Dr. Meissner, in the cramped, semi-dark control room. She watched through the big plate gla.s.s window as the mechanized bed slowly slid through the doughnut hole of the scanner. On the control monitor, she saw a grid with small black-and-white cross sections of Jamie's brain start to appear. It was as though someone had cut him up like a loaf of bread, and spread the slices out, one by one, on a table.

"I don't see any blood," said Dr. Meissner. "At least none that I can be sure of. There's a lot of beam-hardening artifact in the occipital region here, around that device of yours." Dr. Meissner pointed to a bright white area shaped like a starburst. "Something could be hidden there, but I don't see any evidence of bleeding elsewhere. No midline shifts that would suggest swelling. Ventricles look normal in size."

"With all this artifact, you can't see the back of the cranial cavity very well, can you? There could be swelling around the brainstem and we wouldn't see it."

"Yes, that's a big caveat."

Ali got up to go. "All right, thanks, Lou. I guess I'm going to have to do a spinal tap. If there's bleeding, it should show up in the cerebrospinal fluid. Plus it'll give me an independent reading on the intracranial pressure."

"For what it's worth, Ali," said Meissner, pointing to an older CT scan of Jamie's that had been brought up for comparison on a second monitor, "you guys did a beautiful job cleaning out that AVM. It was the biggest one I'd ever seen."

Ali shrugged off the compliment. It doesn't matter how well the surgery went, she thought. What matters is what's happening now.

On his way back from his tete-a-tete with Kathleen Brown, Harry made another swing through the hospital to check on the progress of the search teams. Nada. Not even a rat or a hobo this time. Whoever planted the bomb must have known the hospital pretty d.a.m.n well, and that thought was starting to give Harry heartburn. It took a really sick f.u.c.k to blow up his coworkers and helpless patients who depended on him for survival.

As soon as he could, Harry hurried over to Tower C, to check on his mother's transfer. Finding her bed empty, he broke into his first real smile of the morning. Well, that's done, at any rate. She's out of it now. He blew a puff of breath between his pursed lips, as satisfying as a deep drag from one of those cigarettes he had sworn off the past few months. But his delight was short-lived. Pa.s.sing by the bathroom, he was surprised to see his mother's electric toothbrush on the sink. Oh, h.e.l.l! Did those idiots leave that? Relaxed lips gave way to a stiffening jaw as he scanned the room with cop's eyes, as if inspecting a crime scene. When he spotted her clothes and overnight bag hanging in the closet, his heartburn came back with a vengeance. They haven't moved her at all. She's still a hostage-still in this d.a.m.ned hospital. His fists clenched as if hungry for someone to blame. Nostrils flaring like a bull's, he charged out to the nursing station.

The floor nurse at the station was having a lively chat with a mustachioed young man who looked like a medical student, but Harry cut the conversation short with a brusque display of his ID. "Where is the woman in 18C-7?"

"She went to CT but hasn't come back."

"CT? What for?"

"You'd have to ask Dr. Weiss."

"And where is Dr. Weiss?"

"I don't know. Usually he does rounds with the residents in the mornings. He has patients on four different floors in Towers B and C. He could be anywhere."

"Send an overhead page. I need to talk to him ASAP."

Grudgingly, the nurse picked up the phone. Meanwhile, Harry dialed patient transport on another line. "This is Harry Lewton, chief of security. Did you get my order to transfer a patient named Viola Lewton to Stroger Hospital?"

"Yes," came a man's voice. "An ambulance is standing by. We sent a team up but they couldn't find her."

"They didn't look. She just went for a CT scan, that's all. Get them back up here on the double!"

"I'm sorry," said the dispatcher, bowing to the peremptory tone of Harry's voice. "They did ask around, but they say no one knew where she was."

"Save the excuses. Tell them to meet me at station 18C. I'll take them to get her myself."

The floor nurse motioned to Harry. "Mr. Lewton, you have a call on line two."

Harry hung up on the dispatcher and hit the line selector on the phone.

"Lewton here."

"Harry?"

He was astonished to hear the voice of his sister, Luanne. He had spoken to her a week ago and it had gotten pretty ugly. "I'm kind of busy right now, Luanne."

"Why didn't you tell me Momma was in the hospital? What's wrong with her?"

"A touch of pneumonia, that's all."

"A doctor called me. Dr. Weiss. He said you wanted to take her out of the hospital. He said it was a real bad idea."

"Well, he doesn't know the whole picture. I'm just moving her to a different hospital, that's all. They can care for her as well over there."

"Harry, I told you it was wrong to take her away from that nursing home."

"Yes, you did."

"But you didn't listen. You're not listening to the doctors now, either. You always have to do things your own way."

"It's the only way I know."

"What does Momma say?"

"It's my decision, Luanne. Momma's not in a position to judge."

"I wanna talk to her."

"She's not here. They took her away for a CT scan."

"Do I have to get on an airplane to come there myself? 'Cause, by G.o.d, that's what I'll do. Just 'cause you're the eldest, it doesn't mean the rest of us don't have no rights."

"Settle down. You can talk to her when she gets back to her room."

"I forbid you to move her. You've already done her enough harm. I forbid it."

"Jesus, Luanne! You don't know what you're talking about."

"Don't put me down, Harry. I'm not your kid sister anymore. It was grand what you did for us all back in them days when Daddy got sick. We all looked up to you, Harry-me, Martha, Kyle, and Josie. We're grateful for that. But we're all growed up now, with kids and houses and jobs of our own, and we don't need you makin' decisions for us. We have a say, too. You're gonna have to accept that."

"Can we talk about this later?"

"Later means never with you, Harry."

Harry saw Dr. Weiss coming through the doorway of the ward. "Please, Luanne, I've got a lot to deal with right now. I'll call you tonight. I promise."

"That's not good enough, Harry. I'm gonna hop on that airplane and come see for myself."

Harry did a quick calculation in his head. Even with a nonstop flight out of Houston, there was no way she could get to Fletcher Memorial before 6:00 or 7:00 P.M. The crisis would be over by then, one way or the other. "All right, you do that. It will probably do Momma good to see you. You can stay at my place while you're here."

"Okay." Luanne's voice suddenly sounded more tractable. "I'll call you from O'Hare."

"Bye now." Harry put down the receiver and turned toward Weiss. "Where the h.e.l.l have you been?"

Weiss gave Harry an indignant look. "Taking care of your mother, actually. I had to intubate her and put her on a ventilator. Her blood gases dropped and we had to get a high-resolution chest CT. Her pneumonia's worse and it looks like she could have early signs of ARDS. That's acute respiratory distress syndrome. It has a mortality rate of nearly fifty percent."

"Where is she?"

"I just moved her to the ICU."

"ICU? I told you I wanted her out of here."

Weiss threw up his hands. "You don't trust me? Get another doctor. But she's not leaving this hospital. Not unless you want to kill her."

"It's not about you or about her G.o.dd.a.m.n pneumonia. It's a security matter."