Code White Part 32

Ali did not answer. Carrying the wastebasket, she walked to the corner and checked to make sure that the laparoscopy monitor wasn't plugged in. Walking back, she thought of the wall-mounted station used for dictating operative notes. It had a microphone like the receiver of a telephone, which carried the surgeons' voice input to a departmental computer for electronic transcription. That had to be silenced, too. In her haste, she pa.s.sed between the anesthetist and the scrub nurse's instrument table-an absolute prohibition for someone not in sterile gown and gloves.

"That's it, Dr. O'Day!" said Bittner, throwing down a hemostat. "I'm going to have to ask you to leave this OR at once."

Still Ali said nothing. With a strong tug, she ripped the microphone from the wall and tossed it into the wastebasket. She then carried the wastebasket out of the OR, depositing it outside the door. When she came back into the room she looked back to make sure that the door had shut firmly behind her.

"Dr. Bittner, I am neither distraught nor paranoid," she announced at last. "I take it that you are aware that this medical center is still operating under a Code White?"

"Yes, we've just finished with those unfortunate men from the bomb squad."

"At this moment, our lives are balanced on a knife-edge. The bomb in question has the power to destroy this entire medical center. My husband, Kevin, I regret to say, is ... is at the center of this situation. If he dies, we can expect immediate retaliation, without warning or reprieve."

"Ali, you know as well as I do that your husband is already dead."

"I know." She raised her finger and pointed vaguely toward the ceiling. "But he does not." Her voice was shaking with barely suppressed rage. "He must not know."

"He being whom?"

"Odin. A computer program developed by my husband. The bomb is on autopilot, and Odin controls it. Do you understand? We have to keep working, moving, doing whatever we can to keep the truth from getting out. No one must leave this OR. No word of my husband's condition must get out to anyone. Not even to the police. Can you do this? Promise me. Promise it, Leon. I'm begging you."

"Yes, certainly, Ali," said Bittner with a worried look.

"I don't know how long we can keep it up, but it may give the police enough time to evacuate the hospital or to do something about the bomb."

"Of course. Anything to help."

"You need to know that the communications and security systems of the medical center have been compromised. Every computer, every telephone, every camera is under his control. Everything, everything outside this room is compromised. Do you understand?"

"Yes, I do. I must say, you've got us all pretty frightened, Ali."

"Good. Being frightened may keep you alive."

Just then there was a knock, and the door opened a few inches to reveal the face of one of the nurses from the main OR station. "Dr. O'Day, the Neuro ICU has been trying to reach you, but the phone line in here isn't working."

"The Neuro ICU? What do they want?" She didn't have to ask. No, no, G.o.d! Not Jamie!

"It's your patient, the Winslow boy," said the nurse. "They're running a Code Blue on him."

Code Blue! Ali turned instinctively toward the desk from which she had just ripped out the phone. "Are they still on the line?"

"No. They got disconnected when I tried to transfer them here."

"Are you sure they said Code Blue?"

"Yes, they need you up there STAT."

"But what about Kevin!" she stammered. "M-my husband. Can't you see what's happening here? He's dying. Can't Brower ... Are you sure it's Code Blue? Oh, dear G.o.d-" She felt as though she were caught between two millstones. Jamie dying, Kevin as good as dead. Meanwhile, Odin watched and listened. Five hundred pounds of explosive waited for a deadly spark. It was more than she could stand.

Bittner offered a consoling look. "It's all right, Ali. There's nothing you can do here anyway. Go on up and see what you can do for your patient. We'll keep the show running on this end."

Pull yourself together! she thought. You're a doctor! You live with dilemmas every day! She closed her eyes and took a deep breath. Deergha shvaasam. Deergha shvaasam. She had to control herself. Everything depended on it. If she broke down now, Bittner and all of the staff here would think she was crazy. She had to be strong and set the tone. Deergha shvaasam.

She thought of Harry's dilemma in that burning house in Nacogdoches.

"It's a question of triage," she said at last to Bittner, striving to make every syllable cool and dispa.s.sionate. "The needs of the living outweigh those of the dead. I'll go to Jamie."

"Yes! Yes, go!" said Bittner.

She took one last look at the monitor. Nothing to indicate any electrical activity in Kevin's heart. No contractile impulse. No heartbeat. No life. As she walked past the nurse's desk she took the lens from the security camera out of her pocket and carefully set it on the desk. "Keep an eye on this," she said.

"What is it?" asked the circulating nurse.

"It could be ... a bargaining chip."

Then Ali hurried out, her yellow gown swishing behind her.

In the Neuro ICU, Jamie's bed was surrounded by intensive care specialists, residents, and nurses. Mrs. Gore also stood a little way off, watching apprehensively.

"Thank G.o.d you're here," said Brower when he saw Ali approaching. "His heart rate dropped to less than twenty. We've brought him up to sixty now on atropine, but heart rate and breathing are still very slow. We may have to intubate him if it doesn't clear in the next couple of minutes. It looks like a brainstem herniation."

"What's the ICP monitor show?"

"Normal, but the catheter could just be clogged."

"What about a seizure?"

"Could be a factor. The EEG's diffusely abnormal, but with this device you put in him, I have no idea what his baseline should be."

"Your recommendation?"

"Cut him. Emergency craniotomy. There's nothing more we can do for him here."

Ali looked at the monitors. Failing. Mrs. Gore was standing on the other side of the bed. "Doctor, what's happening?" she said with a tremulous voice. "Is Jamie going to die?"

For an instant Ali's thoughts flashed to Helvelius. Richard would know what to do. He would not be swayed by pride or by vain hope. Ali felt desolate. Although she had made countless decisions on her own, Helvelius had always been her backup. Now she had no one to turn to. "I'm very sorry, Mrs. Gore. We're going to have to remove the SIPNI device." She turned to a nurse beside her. "Anna, could you call down to the Neurosurgical Suite and book us an operating room and an anesthesiologist? Then get transport up here STAT. We need to get him on the table now."

"Right away, Dr. O'Day."

From behind the desk of the nurses' station, Ginnie Ryan called out to her. "Dr. O'Day, there's a phone call for you on line two."

"Is it Bittner?" Oh, G.o.d! she thought. Couldn't they keep Kevin going for five minutes?

She picked up the phone. "O'Day here."

There was a pause. No, it wasn't Bittner. She heard a mellow, masculine baritone voice, speaking slowly and evenly, almost pleasantly, like the television announcer for a sleep aid or a smooth, rich brand of coffee. "WHERE IS KEVIN?" it asked.

"Who is this?" Ali asked, as if she didn't know the answer.

"WHERE IS KEVIN?"

"He's being cared for ... Odin."

"A DIRECT COMMUNICATION LINK WITH KEVIN MUST BE SET UP IMMEDIATELY."

"That's not possible. Kevin has been injured. He is unable to communicate. You already know that."

"THEN RESTORE SURVEILLANCE OF TRAUMA ROOM ONE. YOU WILL UPLINK HIS PHYSIOLOGICAL MONITORING TO ME, SO THAT I MAY a.s.sESS HIS STATUS DIRECTLY."

"No."

"EXPLAIN YOUR FAILURE TO COMPLY."

"There must be a quid pro quo. I will restore surveillance, but only once you have disarmed all bombs in this medical center, and permitted their removal by the police. The bombs are no longer of any use to you. Since Kevin is a patient in this hospital, you cannot detonate them without harming him. It's safest for everyone-"

She heard a click and then a dial tone. "Odin? Odin?" Still holding the phone, she turned and shouted directly into one of the computer monitors at the nurses' station, as the surrounding staff looked on with alarm. "Restore communication, Odin! Speak to me. For G.o.d's sake, listen to me!"

The monitor had gone blank, except for a single number "30," about an inch high, in the center of the screen. When Ali looked around the room, she saw that each of the half dozen computer monitors showed exactly the same image.

It was not long before she knew the reason why. On the overhead speakers, she heard a chime in the interval of a rising fourth, and then the same silvery baritone voice that had just spoken on the telephone: "TIME TO DETONATION: 30 MINUTES."

In place of the number 30, each screen now showed a 29 and a seconds' register beside it, whirling steadily downward to the thousandth decimal place.

Countdown had begun.

5:40 P.M.

Ali hung up the phone and turned to the ICU attending. "Dr. Brower, we need to start evacuating these patients immediately."

"To where?" he asked, skeptically.

She looked around. There were ten patients, most of them semiconscious. All were hooked up to monitors and IV pumps. Two needed respirators to breathe. Total manpower on hand consisted of half a dozen nurses, one intern, Mrs. Gore, Brower, and herself. "I ... I don't know. But in thirty minutes this tower is going to be a pile of dust."

"Did you call transport?"

"Forget transport. We have to do it ourselves. Start with those beds near the door."

"These patients aren't stable enough to be moved."

"G.o.d, Stephen! Anyone not moved is going to die. Remember what happened to Richard in the elevator? What you're hearing on the overhead is not a drill."

"Let me check with security. They have a protocol for this."

"Fine! You do that!" She went to the center of the room and scanned the names and faces of the patients. It would take fifteen minutes or more to move one bed to the first floor. There wouldn't be time to get them all out. Triage, she thought. You take the youngest and healthiest first. That stroke case in the corner goes last. He's not going to survive the night anyway.

Moving to bed one, nearest the door, she kicked the bed brake into the off position. "Ginnie! Anna! Luisa! Get over here!" With Ginnie's help, she unscrewed the vitals monitor from its stand and placed it between the patient's feet. "Anna, move this bed downstairs to the main lobby. By the time you get there, someone should be directing the evacuation. Do whatever they say, leave the bed behind, and then hightail it back here. Take the stairs back, not the elevator. Got that? Move it! Move it!" No sooner had Anna crossed the threshold, than Ali had Luisa follow her with the next bed. "Get going! On the double! If you meet a spare set of hands on the way, send them back here!"

"Stop it!" said Brower with the phone to his ear. "This is my ICU. These are not even your patients. I can't permit this."

"Write me up tomorrow, Stephen. But for now, either lend a hand or keep out of the way."

Ali looked over toward bed seven, where Mrs. Gore stood beside Jamie with a bewildered look. Ali's heart stopped as she surveyed Jamie's tiny, already nearly lifeless form. There was no chance of a craniotomy now, and if Jamie was really herniating, with ma.s.sively high intracranial pressure forcing the brain into the narrow ca.n.a.l of the spinal cord, he would be dead within minutes. The vital centers regulating breathing and heartbeat would be crushed. The rules of triage said he should be evacuated last. But Ali couldn't accept that. He's young. The young are never hopeless. I'm not going to give up on him.

She rushed to his bedside to examine him herself. If there really was herniation, the pressure would be great enough to close off the small veins at the back of the eyeball, and she would be able to see the resulting engorgement of blood, a sign known as papilledema. Turning the light up to full brightness, she shined an opthalmoscope through Jamie's right pupil. Nothing abnormal. She tilted Jamie's head toward her and looked into the left eye. Again, not a trace of papilledema. Perhaps Brower was wrong. Perhaps it was a seizure.

"Is he going to be all right now?" asked Mrs. Gore with a mix of expectancy and trepidation. What a ridiculous question, thought Ali. Can't you see how much trouble we're in? But then she saw that Mrs. Gore was nodding toward the vitals monitor. Jamie's heart rate was now eighty, his respiration twelve, and his blood pressure normal. But even as Ali watched, all the indicators were drifting back downward.

Now it was heart rate fifty-eight, respiration eight. Did I miss something on the exam? Ali checked Jamie's eyes with the ophthalmoscope again. Nothing. But when she looked up, the heart rate had climbed back to eighty-two.

Is this possible? Holding Jamie's eyes open, she shined the light back and forth, while watching the monitor. Jamie's heart rate rose and stabilized at around ninety beats per minute, and his respiration and blood pressure became normal, but only as long as she continued shining the light. When she moved the light away, the vital signs drifted down again.

Could it really be that simple? Ali remembered that the SIPNI device integrated itself by sending out test pulses, gathering together circuits that were originally meant to converge on the visual center of the brain. These were, by definition, circuits that had their start in the perception of light within the eyes. But Jamie's circuits were starved for light. He was lying with his eyes closed in a dimly lit room. With no visual input to guide it, the SIPNI device was sending out signals randomly into the brain, creating a steady-state seizure that was disrupting the vital control centers in the brainstem.

If that was true, the solution was to flood Jamie's brain with light-as much light as possible.

"Yes, Mrs. Gore, I think there is a chance that Jamie is going to get better. But he needs your help. You need to hold his eyes open, like this." She demonstrated. "Can you do that? I'll get you some tape to help with it." As Mrs. Gore leaned over the side of the bed, Ali switched on a wall-mounted light on an accordion bracket, and directed it toward Jamie's face. "He needs to see the light. Keep him looking at it, okay? We're going to be moving him out in a minute, and in the meantime I'm going to try to locate a phototherapy light-a special light that's as strong as daylight. That should be exactly what he needs."

Ali turned away from the bed, and was startled to see an Asian man dressed in black standing close behind her. It was Special Agent Raymond Lee. Scopes was also with him, taking up a position about midway from the door.

"Dr. O'Day, I need you to come with me," said Lee.

"I don't have time for your third degree, Mr. Lee. I have a patient in crisis here. We're in the midst of an evacuation. If you want to be of use, then help push some of these beds down to the lobby."

"If you refuse to come, I'll place you under arrest."

"On what charge?"

"Conspiracy to commit extortion and murder."

"That's preposterous. I have nothing to do with this bomb and you know it. Get out of here and let me take care of my patient."

"Logline says you took a phone call here from Odin not more than five minutes ago, just before the countdown began. That's a pretty d.a.m.ning coincidence."

"No. That was-"

"I don't have time for explanations. Come with me now. If you're innocent, prove it by helping us shut this computer down."

"I don't know how to do that. If I did, I would have done it long ago. I've already been over this with Harry Lewton. Ask him. He was the last person to speak with Kevin."

"It's not Harry Lewton's call." Lee reached into his back pocket and pulled out a pair of handcuffs. As if by reflex, Ali stepped back and pushed an IV pole between herself and Lee. Seeing her resistance, Scopes started moving in.

"Wait a minute!" cried Mrs. Gore. "Are you going to arrest the doctor? What's going to happen to Jamie?" She pushed her arm in front of Lee, blocking him. At the same time, the short but rotund Dr. Brower planted himself in Scopes's path.

Remembering the pocket alarm Harry had given her, Ali groped for it in the pocket of her scrub top, found it and pressed the b.u.t.ton. Harry, I need you! Oh, please G.o.d, let the receiver still be on!

"I don't believe this," Mrs. Gore continued. "You should be ashamed of yourselves. Where's your heart? The doctor is keeping this boy alive. He's not a n.o.body. He's been on national TV. If anything happens to him, questions will be asked. The reporters are right here in this building. I'll raise G.o.dd.a.m.ned h.e.l.l. I will. Don't think I won't do it!"

"Please step back, ma'am," said Lee.