Code White Part 2

In her mind, Ali was still facing Kathleen Brown and the pitiless blinking red eye of America Today-endlessly replaying that string of flubs, which was all she could recall of her performance. Why did the right thing to say always occur to her just when it was too late to say it? The experience had left her so fl.u.s.tered that she could hardly think about the operation, and that upset her more than anything. I've got to shake this. I can't afford to lose control, she thought as she snapped a pair of chocolate-colored surgical gloves onto her hands. I musn't let Jamie down. She looked across the room, toward the still form of Jamie Winslow, barely visible through the drapes and trays. Stay calm, she told herself. Remember that Jamie is what this day is about.

Ali had met Jamie a few months before, when his legal guardian, Mrs. Gore, brought him to the Department of Neurosurgery. Five other neurosurgeons had written him off as hopeless, and with good reason. The tumor inside his head was a Grade V on the Spetzler-Martin scale. It was huge, it was deeply entangled with the brain's vital blood supply, and it nestled directly against what the neurologists referred to as "eloquent cortex"-indispensable parts of the working brain. If it were taken out too abruptly, the gush of new blood into old deserts could have burst the arteries, leaving Jamie paralyzed, speechless, or even locked into an irreversible coma state. There was no question of restoring his eyesight: both sides of his visual center had long since been destroyed by the AVM.

Every surgeon who had looked at Jamie had concluded the same thing. There was nothing to justify the awful risks of surgery. Yes, there was a big chance that the AVM could kill him some day: it might break open and bleed without warning, or it might simply keep on growing until it had crushed the life-sustaining centers in the brainstem. But that would be in the course of nature. No surgeon wanted this young boy's death on his own hands. The Hippocratic Oath said it succinctly: "First do no harm."

But Jamie Winslow did not have the look of the hopeless. It was hard to give up on him. When Ali first walked into the examining room to meet him, he c.o.c.ked his head, gave her a big, toothy smile, and asked her whether she had had a good time in California.

"Yes, I just flew back from San Diego, from the Annual Meeting of the American a.s.sociation of Neurological Surgeons. It's like a weeklong school for doctors. How did you know that?"

"You sound really sleepy. People's voices go down at the end when they've been up all night flying on airplanes."

"Yes, I took a red-eye flight. But California?"

"I can smell the smoke in your hair."

"Smoke? What do you mean?"

"There's some really big fires burning in Southern California right now. I've been hearing about it on TV, 'cause a lot of firemen from here in Chicago have gone over there to help out. That kind of smoke has a special smell. It's not like cigarettes or anything. I smelled it a couple of years ago when we went to Chain O'Lakes Park and they had a prairie fire."

"That's amazing. Yes, there was a haze everywhere. You could smell the smoke from the mountains. But I had no idea that I had carried it back with me."

"Sure, I can smell it." Jamie c.o.c.ked his head and lowered his voice, like a conspirator. "So did you play hooky from that doctor meeting you went to?"

"What do you mean?"

Jamie grinned, his gums showing in the place of a missing upper tooth. "Your suntan lotion. I can smell that, too."

His smile was like a sun that never dimmed, despite a pall of illness, loss, and abandonment that would have dimmed the spirit of many who had traveled further in life. After his father was killed in Afghanistan, his mother was unable to care for him and turned him over to the custody of the courts. For two years, he had lived at the Grossman School for the Blind in Wheaton, where Mrs. Gore, a dormitory matron, acted as his legal guardian. He was bright and friendly and did well in school, learning to read in Braille and getting high marks in arithmetic. But an impish insistence on doing things his way had earned him more than a few detentions. Had he not been shielded from harsher discipline by Mrs. Gore, his natural-born independence might have progressed to outright rebellion.

At the Grossman School, he was learning swimming and goalball. But baseball was what he really cared about. All through the spring and summer, he followed the Cubs and the White Sox on the radio, his spirits rising and falling with every crack of the bat. He liked the simplicity of the game. Football and basketball were too complicated to follow without the aid of sight. But in baseball, he could reconstruct everything that happened from what the radio announcers said. There was a moral simplicity to it, too, so plain that even a seven-year-old could understand it. Every man stood alone at the plate, his fate tied to his unique strengths and weaknesses, like a Greek hero. Jamie could identify with that. It was a mirror of what he saw life to be.

When Dr. Helvelius once asked him what he would do if he got his sight back, his answer was immediate. "Baseball. I'm gonna be a major league baseball player. One day, I'll lead the Cubs to the World Series. You'll see I will!"

As for Ali, once the mesquite smoke was out of her hair, Jamie always professed to dislike her smell of iodine and harshly laundered scrub suits. But her accent fascinated him. Few people ever noticed it. She had moved to New York as a little girl, and here in the Midwest, New York was all they heard. Jamie picked up on an older accent, out of the cradle, that had been almost erased, like the old writing on a palimpsest. He pestered her until she finally explained it to him, and from then on she was "Dr. Nefert.i.ti" to him. Dr. Nefert.i.ti. She didn't take offense, for it was a recognition of a secret bond. Each had had to overcome adversity and sorrow. Each knew what it was to be an alien.

Ali was aware that her relationship with Jamie was not objective. She had met him at the lowest point in her life, a time when she could hardly bear to drag herself out of bed each morning. When he first showed up in her clinic, it was as though the clouds had parted for the first time after a long, brutal, numbing winter. His rollicking laughter and breathless questions about wildfires and mummies and star travel and the New York Yankees beguiled her and made her forget her own loss. She looked forward to his visits, and then felt a gnawing emptiness each time Mrs. Gore led him home. In her restless nights, she would soothe herself to sleep thinking about Jamie's gap-toothed smile, or the way his pink ears poked through his curly hair, or the last silly knock-knock joke he had told. Ali had been taught that it was wrong or even dangerous to take pleasure like that from a patient. A surgeon cuts people. Life and death decisions had to be based on cold mathematical probabilities, and not on the promptings of the heart. But Jamie was not a typical patient. He was a helpless seven-year-old boy without a father or mother to love him. And Ali couldn't resist wanting so much more for him than a doctor could give.

Her feelings had already profoundly affected the course of the SIPNI project. SIPNI was supposed to be tested first on an elderly patient, someone who had little to lose if things went wrong. But Ali believed strongly that Jamie deserved a chance at a full life. When the IND-the government-sanctioned Investigational New Device approval-finally came through, allowing the SIPNI device to be tried on a human being, she had argued relentlessly that it should be Jamie who got the first trial. She won out, but she had taken an awful risk. For if Jamie wound up being hurt, the responsibility would be hers alone.

The operating room door swung again as Dr. Helvelius made his entrance. This was the signal for someone to hit play on a CD player. In a moment, the room was filled with the sound of Media vita in morte sumus, a responsory from the Gregorian chant.

"Could we have a little anesthesia, please?" said Helvelius gaily, as though ordering a bottle of chablis.

"He's under," came a voice from behind the blue screen that separated the brightly lit circle of scalp from the rest of Jamie Winslow. It was Dr. G.o.doy, the anesthesiologist, who spoke so softly that Ali could barely hear him above the whoosh of the bellows of the anesthesia machine.

"Radiology ready?"

A gowned figure nodded from beside the portable fluoroscope across the room.

Helvelius looked into the Betacam in the corner. "We're going to start with a pre-op angiogram to give us an idea of what the blood vessels look like inside Jamie's brain. Get the lay of the land, so to speak. We can't afford any surprises once we open him up. Dr. O'Day, would you be so kind as to start the catheter?"

Ali looked at Helvelius with surprise. The catheter insertion was a routine but sometimes messy procedure, usually performed by a resident from Interventional Radiology. "You don't want radiology to do it?"

"Not today. I'd like a sure hand."

Sure hand? Ali still felt shaky from her agonies in front of the camera.

But it was no time to demur. The camera was running, and Ali had to proceed. Turning from the scrub nurse who had just tied the back of her operating gown, she pulled back the edge of a blue paper drape over Jamie's right groin, where the skin had been painted iodine yellow. She felt for a pulse, then cut a one-eighth-inch nick in the skin and used a fine hemostat clamp to tunnel into the opening.

"Dr. O'Day will be pa.s.sing an ultrathin catheter tube into an artery in Jamie's leg. It will have to travel through the main artery, the aorta, almost to his heart, and from there through the neck until it reaches the circle of arteries at the base of the brain. We will use this catheter to inject a puff of dye, which we can photograph on X-ray."

Ali was amazed at Helvelius's self-a.s.surance. Here she was, nearly paralyzed by the unnatural scrutiny of these spotlights, and he seemed to frolic in their glow. Where did he get that kind of confidence?

But before her lay the artery, pulsating, glistening white. Focus, now! This is all you have to worry about. Just this artery. Just this one little task. Deftly, Ali pushed a large twelve-gauge needle at a forty-five-degree angle through the opening, thrusting toward Jamie's pulse. A couple of small spurts of blood showed that the needle was inside. Then Ali attached the introducer, shaped like a big metal Y, and through this pa.s.sed a thin guide wire for the catheter. The guide wire glided without resistance for a foot or so, until it had reached the aorta, the central artery of the body.

Then she was done. Ali stepped back as the C-shaped arms of the fluoroscope were brought forward and positioned above and below Jamie's body, like the claw of a giant crab. The next job belonged to the lead-ap.r.o.ned radiologist, who, guided by the images from the fluoroscope, would inch the wire forward through the abdomen, chest, and neck, until it had reached the base of the brain itself.

Because of the radiation emitted by the fluoroscope, the room was cleared while the radiologist worked. Only Ali and Dr. Helvelius remained, watching from a small island of safety behind a lead screen. Both clasped their gloved hands against the sterile fronts of their gowns, to avoid contamination.

A shadow fell over Ali's face as Helvelius inclined his head toward her. Behind his yellow paper mask, behind his surgical spectacles with the binocular loupes that made him look almost like a robot, she thought she detected a smile. "You know, it's all I can do to keep from s-s-sweeping you into my arms this very minute," he whispered.

"Don't be a fool, Richard." Ali chuckled. "The camera's running."

"d.a.m.n the camera! Let the whole world know! I l-love you and I don't see why I should be ashamed of it."

"Your reputation-"

"Means nothing to me. Not if it's going to stand in our way. I want you, Ali. I want you to m-marry me. I don't care about anything else."

She turned away abruptly and cast her gaze on the floor. "I'm not ready," she said.

"Is it because I'm old?"

"No. No, don't say that. It's me. It's.... it's..." She paused and took a deep breath. "It's Kevin."

"Kevin? You left him months ago. You sent him divorce papers."

"I know, I know. But he hasn't filed any response with the court. In fact, he hasn't spoken a word to me about it, which isn't like him. When we have to talk about the SIPNI project, he acts like nothing's happened. That frightens me."

"He already knows everything, Ali. C-c-can't you see it in his eyes?"

"I'm not sure what I see. I know he's gone to a dark place, but he's pulled a veil over it. I don't want to hurt him. Don't you understand? I don't want to push him over the brink."

"So you still care for him."

"I never said I quit caring about him. I said I couldn't bear to go on living with him."

"I don't see why the two of you can't just sit down and have it out."

"You know why, Richard." She looked at him briefly, and then turned away. "I don't handle confrontations well. I get sick inside just thinking about it. I guess, well, I'm a coward."

"No, you're not a coward. Look, it's not f-fair of me to pressure you. The fact is, Ali, I'll take you any way I can have you. I'm living the happiest days of my l-l-life right now."

"You're not jealous, then?"

"Pure Kelly green." Unable to embrace her with his sterile hands, Helvelius swung his leg behind her and gently pressed his shin against her calf. "My ex was never so understanding when we split up. G.o.d, how could K-Kevin not see what he's throwing away!"

"Don't be jealous, Richard," she said, taking pleasure in the warm touch of his leg. "I do want to be with you."

"Your rotten luck!" he said, his smile showing through his mask again. "I know I'm an old dog. Surgery has been my w-wife, my kids. It's what I've lived for all these years. But now ... now I want more. So much more. This b-baby ... It could be like a second chance for me. For us. We could-"

Ali suddenly stiffened and pulled her leg away. "Please don't call it a baby," she said. "That's like giving it a name."

"Well, what is it, for G.o.d's sake? Why are you intent on getting rid of it? When you were carrying Ramsey, you w-wanted a child more than anything."

She shut her eyes tightly, as if trying to escape an inner vision. "Don't talk about Ramsey," she snapped.

"Ali, I was there. I remember how rough it was for you. If you're worried that ... we can get the best prenatal evaluation."

Ali felt a wave of nausea building. "I can't do it, that's all," she said. "I can't bear to even hope for anything anymore. It's the hoping that hurts."

"At least think about it. P-p-promise me that."

"Look, Richard, I don't even know it's yours."

Indeed, she did not know.

Nine weeks and two days ago. It had been a long, awkward day with Kevin in the lab. They were performing a critical experiment for SIPNI, a test that everyone hoped would prove to the FDA that the device was ready to be tried on a real patient. SIPNI had been wired to a camera, and its ability to distinguish pattern, motion, and perspective was compared to a group of medical student volunteers. For seven hours, Ali and Kevin sat together in a semidarkened room, keeping score while test images and snippets of movies were projected onto a screen. They avoided speaking about the elephant in the room-Ali's move out of the apartment-and tried to focus on the test. After some early glitches, SIPNI's learning curve took off, so that by late afternoon the poor medical students got the pants beaten off them by a gizmo the size of an egg. SIPNI could instantaneously count 1,031 pencils in a jumbled pile, and identify the one pencil in 1,031 that had no eraser. In less than a second, it could do the same thing from a movie of the pencils being poured out of a canister. By every yardstick Ali and Kevin could devise, SIPNI saw more sharply, more vividly, more discerningly, and in more colors than the human eye and brain. Three years of work had culminated in a resounding success. The FDA would have no choice but to grant approval.

There had to be a celebration. As the experiment broke up, Kevin suggested a late dinner together at Napoli, a quiet Italian hole-in-the-wall on Damen Avenue that had been his and Ali's favorite for years. An innocent suggestion-except with Kevin, nothing was ever innocent. Everything was a move in a chess game. Ali felt uneasy about it from the start. As she drove to meet him at the restaurant, there was one point, waiting at a light, when she almost turned the car around. But it's the least you can do, she thought. You walked out leaving a Dear John letter on the dresser. He deserves a face-to-face explanation. The restaurant, she knew, would be safe. If he made a scene, she could quickly leave.

She was little prepared for what did happen. Kevin was as gentle as a puppy. He rose to greet her as she came through the door. He ushered her to their "special" booth in the back, and ordered for her, faultlessly remembering her penchant for funghi ripieni, stracciatella alla romana, and tortolloni quatro formaggi. There were no recriminations. He spoke only of how much he missed her, how cold and dark the apartment was without her. He reminisced about a trip they had taken to the Valle d'Aosta, in the Italian Alps, and how they had once planned to spend a summer walking the Grande Traversata together. And then he asked her point-blank to come back. He spoke feelingly, without guarding himself, without trying to hide the pain in his eyes or the nervous quaver in his voice. It was the hardest thing for him to do, she knew, to surrender his pride like that.

No, it's too late, she ought to have said. But her heart went soft at the sight of him pleading like a little boy. He seemed so different from the sarcastic egotist who had driven her away. Could he have changed? Had she judged him too hastily? She had brooded over her decision every hour of every day since moving out. Now, she was less sure than ever.

Without answering him directly, she touched him on the hand and suggested they go for a walk. He paid the check quickly, without looking at it. Outside, the spring night was warm. Tying her sweater around her waist, Ali put her hand under Kevin's arm and strolled with him down Division Street. Old habit seemed to guide them in the direction of their apartment a few blocks away. Kevin spoke little, relying on her reminiscences to speak for him, as they pa.s.sed the tree-lined blocks of sidewalk cafes, Polish delicatessens, boutiques and craft stores where Ali loved to browse on her rare free weekend hours. Then, in front of the gray beaux arts edifice of the Russian baths, with its twin arched doorways, they both paused, a little nervously.

"Want to come up for a minute?" asked Kevin. Ali nodded and started up the side street with him. A few steps, and they were in front of an old brownstone with large bay windows. Kevin led her onto the porch, and then up a narrow, creaking staircase to the apartment on the middle floor. Crossing the threshold, Ali felt strangely divided, as though she had come home, and yet was a total stranger. It was remarkable how nothing had been changed. Pa.s.sing through the bedroom to freshen up while Kevin made espresso, she noticed that her bedroom closet and dresser drawers were still empty. In the bathroom, her favorite soap and shampoo still sat on the edge of the tub, and a hairbrush she had left behind lay untouched beside the sink. He's waiting for me, she thought. Waiting and hoping. Is that romantic instinct, or denial?

When she came out of the bathroom, she had decided to take a chance on making love to him. She didn't want to humiliate him by forcing him to ask. She took the initiative herself, tearing his shirt from him so smartly that one of his b.u.t.tons went flying. She kissed his lips, his jawline, his nipples, and pulled him down with her onto the bed. Kevin was astonished but answered with a blaze of ardor, not suspecting that it was all a gesture on her part-a hollow caricature of the pa.s.sion she had once felt for him. He was exquisitely attentive, clinging to her body the way a drowning man clings to a lifeline. Something in his neediness brought her back to life. He wants me. How can I not want to be wanted like this? She began to feel a warm glow within her, the first wavelets of a tide of joy and surrender.

And then, with a single word, he drove a stake through her heart.

"Ramsey!" he huffed. "We'll make another Ramsey, babe. We'll put that business behind us for good."

Ramsey! She dried up instantly, and her hands and feet turned cold. Ramsey! Before her mind's eye flashed a pool of blood. She saw a gla.s.s-walled ba.s.sinet, and a pink, doll-like form, writhing under a bright, inhuman light. A silent scream arose within her....

For over a year, she had fought to expunge this memory. At times, death itself had seemed better to her than to go on seeing that tortured face, those tiny, hopelessly grasping hands, that blood ... that sudden, shocking, tragic blood. Kevin knew this, and still he had stuck his finger in the sore. How long had he planned that ill-timed remark? Since Division Street? Since the restaurant? Weeks ago? Here was the old Kevin-the Kevin she had walked out on-obsessive, manipulative, and self-centered. He was pushing her beyond where he knew she could go.

It was all she could do not to throw him off her. She let him finish, but her thighs were stiff, and her hands held his upper body away from hers in a gesture of disgust. The minute he was done, she rolled away and sat on the edge of the bed, her heart pounding, her breath strained by an anvil-like pressure on her chest.

Kevin saw her anguish, but not with the eyes of pity. In fact, it infuriated him. Gone was the pleading little boy. Gone was the pa.s.sionate lover.

"There you go again! Don't turn your f.u.c.king back on me! Quit holding on to your grief, like it was some precious, private jewel that no one but you has a right to see! I have a right! I lost him, too!"

"d.a.m.n you, Kevin!" was all she could say.

"Yeah, I said the forbidden word. Ramsey! Go ahead, curse me for it! Scratch my eyes out! Turn around and let me have it! But you can't, can you? What the f.u.c.k is wrong with you, anyway? You walk around with your head full of ghosts: your father, your sister, your ... your ... our son, that pathetic little tyke who squirmed in agony for a few days before his life was snuffed out altogether. If you believe in G.o.d, why can't you curse Him, and scream at the top of your lungs how b.a.s.t.a.r.dly s.h.i.t-f.u.c.king unfair that was? Any normal human being would do that. If you keep it locked up inside you, it will kill you. It will drive you insane."

She stared at the floor, trying to shut him out. His words enraged her. She burned to shriek at him, to throw back his accusations, and in so doing to flush clean the sewers of pent-up rage and grief inside her. But she couldn't. The very thought of confronting him made her ill, as every attempt to stand up for herself always had. Why? Why? she had asked herself a thousand times before. It was as though an unseen hand were poised to crush her if she dared to reveal the intensity of what she felt. It had always been so, as far back as she could remember. For all her training and degrees, she was helpless to do anything about it. She had the skill to cut into the brains of others, but could not heal this abscess within her own.

She knew that so much was at stake. It was the last chance to save her marriage, and yet she found her tongue paralyzed. She couldn't even cry. All she could do was stare at the floor and breathe, deep in, deep out, trying to ward off that stomach-turning feeling of doom.

Meanwhile, Kevin made his jab for the jugular. "I suppose you think that son of a b.i.t.c.h Helvelius has got the answer."

Ali rose to her feet. "Richard has nothing to do with it," she said, jerking her panties and skirt back up around her waist. "It's just like you to be suspicious of everyone. Nothing's happened. We just ... talk. He ... he doesn't try to force me.... He accepts ... accepts me for who I am."

"Do you think I believe that?"

"I don't care what you believe."

"You're never going to change, are you, babe?"

"Who ever changes? Do you?" she said, without looking back. The next thing she was standing alone on the front porch of the brownstone, shivering in the warm night air. Only then did she notice that she had put on her blouse so hastily that the b.u.t.tons didn't line up. I'm a d.a.m.ned fool, she thought. If I don't end it, we're both going to lose our minds.

The next day she filed for divorce. And two days later, she made love to Helvelius for the first time.

Clack! Clack! The radiologist slapped the finished angio films against the clips at the top of the lightbox. While the rest of the staff returned to the room, Ali scooted from behind the lead screen to view the images. A dark blob, like an unraveling ball of yarn, could be seen in the back of the skull cavity, marking the location of the AVM.

"There's the main feeder," said Dr. Helvelius, looking over her shoulder. In his voice there was no trace of what had just pa.s.sed between them-no baby, no Ramsey, no wedding bells.

"Looks like it comes directly off the posterior communicating artery," said Ali, trying to match his composure, although nausea still wrung her stomach, and she felt weak and shaky inside.

"Do we have digital?" asked Helvelius. "Kevin, do you have it?"

Kevin was slouched far backward in his chair, punching the keyboard crisply with one outstretched hand. Despite his swagger, Ali could tell that he was far from at ease. Shorn of his characteristic smirk, he seemed deep in thought, even apprehensive. She was glad to see it, for he was always like that when he was immersed in work-and work, she knew, was his solace. It was the great unifier, too. Over the past few months, Kevin had increasingly isolated himself in his laboratory. But now, with SIPNI on the verge of realization, how could he help but feel a bond with those who were gathered in this room to bring the dream to life? In that might lie the germ of healing and forgiveness.

"Yes, yes, I have it," he said. "I'm running it past Odin now."

Kevin flicked the switch to the audio box, releasing Odin's soporific voice.