The Surgeon Read online

  She placed the damp cloth on the patient’s abdomen. Only then did she realize that the old man was not breathing.

  At once Angela felt the neck for a pulse.

  “What is it?” asked the son. “Is he okay?”

  She didn’t answer. Pushing right past him, she ran into the hall. “Code Blue!” she yelled. “Call a Code Blue, Room Five-twenty-one!”

  Catherine sprinted out of Nina Peyton’s room and rounded the corner into the next hallway. Personnel had already crowded into Room 521 and spilled out into the corridor, where a group of wide-eyed medical students stood craning their necks to see the action.

  Catherine pushed into the room and called out, over the chaos: “What happened?”

  Angela, Mr. Gwadowski’s nurse, said: “He just stopped breathing! There’s no pulse.”

  Catherine worked her way to the bedside and saw that another nurse had already clapped a mask over the patient’s face and was bagging oxygen into the lungs. An intern had his hands on the chest, and with each bounce against the sternum he squeezed blood from the heart, forcing it through arteries and veins. Feeding the organs, feeding the brain.

  “EKG leads are on!” someone called out.

  Catherine’s gaze flew to the monitor. The tracing showed ventricular fibrillation. The chambers of the heart were no longer contracting. Instead, the individual muscles were quivering, and the heart had turned into a flaccid bag.

  “Paddles charged?” said Catherine.

  “One hundred joules.”

  “Do it!”

  The nurse placed defibrillator paddles on the chest and yelled, “Everyone back!”

  The paddles discharged, sending an electrical jolt through the heart. The man’s torso jerked off the mattress like a cat on a hot griddle.

  “Still in V. fib!”

  “One milligram epinephrine IV, then shock him again at a hundred,” said Catherine.

  The bolus of epinephrine slid through the CVP line.

  “Back!”

  Another shock from the paddles, another jerk of the torso.

  On the monitor, the EKG tracing shot straight up, then collapsed into a trembling line. The last twitches of a fading heart.

  Catherine looked down at her patient and thought: How do I revive this withered pile of bones?

  “You want—to keep—going?” asked the intern, panting as he pumped. A drop of sweat slid in a glistening line down his cheek.

  I didn’t want to code him at all, she thought, and was about to end it when Angela whispered into her ear:

  “The son’s here. He’s watching.”

  Catherine’s gaze shot to Ivan Gwadowski, standing in the doorway. Now she had no choice. Anything less than a full-out effort, and the son would make sure there was hell to pay.

  On the monitor, the line traced the surface of a storm- tossed sea.

  “Let’s do it again,” said Catherine. “Two hundred joules this time. Get some blood sent for STAT lytes!”

  She heard the code cart drawer rattle open. Blood tubes and a syringe appeared.

  “I can’t find a vein!”

  “Use the CVP.”

  “Stand back!”

  Everyone stepped away as the paddles discharged.

  Catherine watched the monitor, hoping that the jolt of shock-induced paralysis would jump-start the heart. Instead, the tracing collapsed to barely a ripple.

  Another bolus of epinephrine slithered into the CVP line.

  The intern, flushed and sweating, resumed pumping on the chest. A fresh pair of hands took over the ambu-bag, squeezing air into the lungs, but it was like trying to blow life into a dried-out husk. Already Catherine could hear the change in the voices around her, the tone of urgency gone, the words flat and automatic. It was merely an exercise now, with defeat inevitable. She looked around the room, at the dozen or more people crowded around the bed, and saw that the decision was obvious to them all. They were just waiting for her word.

  She gave it. “Let’s call the code,” she said. “Eleven thirteen.”

  In silence, everyone stepped back and regarded the object of their defeat, Herman Gwadowski, who lay cooling in a tangle of wires and IV tubing. A nurse turned off the EKG monitor, and the oscilloscope went blank.

  “What about a pacemaker?”

  Catherine, in the midst of signing the code sheet, turned and saw that the patient’s son had stepped into the room. “There’s nothing left to save,” she said. “I’m sorry. We couldn’t get his heart beating again.”

  “Don’t they use pacemakers for that?”

  “We did everything we could—”

  “All you did was shock him.”

  All? She looked around the room, at the evidence of their efforts, the used syringes and drug vials and crumpled packaging. The medical debris left behind after every battle. The others in the room were all watching, waiting to see how she would handle this.

  She set down the clipboard she’d been writing on, angry words already forming on her lips. She never got the chance to say them. Instead she spun toward the door.

  Somewhere on the ward, a woman was shrieking.

  In an instant Catherine was out of the room, the nurses right behind her. Sprinting around the corner, she spotted an aide standing in the hallway, sobbing and pointing toward Nina’s room. The chair outside the room was vacant.

  There should be a policeman here. Where is he?

  Catherine pushed open the door and froze.

  Blood was the first thing she saw, bright ribbons of it streaming down the wall. Then she looked at her patient, sprawled facedown on the floor. Nina had fallen halfway between the bed and the door, as though she had managed to stagger a few steps before collapsing. Her IV was disconnected and a stream of saline dribbled from the open tube onto the floor, where it formed a clear pool next to the larger pool of red.

  He was here. The Surgeon was here.

  Though every instinct screamed at her to back away, to flee, she forced herself to step forward, to drop to her knees beside Nina. Blood soaked through her scrub pants, and it was still warm. She rolled the body onto its back.

  One look at the white face, the staring eyes, and she knew Nina was already gone. Only moments ago I heard your heart beating.

  Slowly emerging from her daze, Catherine looked up and saw a circle of frightened faces. “The policeman,” she said. “Where is the policeman?”

  “We don’t know—”

  She rose unsteadily to her feet, and the others backed away to let her pass. Heedless of the fact she was tracking blood, she walked out of the room, her gaze darting wildly up and down the hallway.

  “Oh my god,” a nurse said.

  At the far end of the corridor, a dark line was creeping across the floor. Blood. It was trickling out from beneath the supply room door.

  thirteen

  Rizzoli stared across the crime scene tape, into Nina Peyton’s hospital room. Spurted arterial blood had dried in a celebratory pattern of tossed streamers. She continued down the corridor to the supply room, where the cop’s body had been found. This doorway, too, was crisscrossed by crime scene tape. Inside was a thicket of IV poles, shelves holding bedpans and basins, and boxes of gloves, all of it zigzagged by blood. One of their own had died in this room, and for every cop in the Boston PD the hunt for the Surgeon was now deeply, intensely personal.

  She turned to the patrolman standing nearby. “Where’s Detective Moore?”

  “Down in Administration. They’re looking at the hospital surveillance tapes.”

  Rizzoli glanced up and down the hall but spotted no security cameras. They would have no video footage of this corridor.

  Downstairs she slipped into the conference room where Moore and two nurses were reviewing the surveillance tapes. No one glanced her way; they were all focused on the TV monitor, where the tape was playing.

  The camera was aimed at the 5 West elevators. On the video, the elevator door opened. Moore froze the image.

  �
��There,” he said. “This is the first group to come off the elevator after the code was called. I count eleven passengers, and they all get off in a rush.”

  “That’s what you’d expect in a Code Blue,” said the charge nurse. “An announcement goes over the hospital speaker system. Anyone who’s available is expected to respond.”

  “Take a good look at these faces,” said Moore. “Do you recognize everyone? Is there anyone who shouldn’t be there?”

  “I can’t see all the faces. They step off in one group.”

  “How about you, Sharon?” Moore asked the second nurse.

  Sharon leaned toward the monitor. “These three here, they’re nurses. And the two young men, at the side, they’re medical students. I recognize that third man there—” She pointed to the top of the screen. “An orderly. The others look familiar, but I don’t know their names.”

  “Okay,” said Moore, weariness in his voice. “Let’s watch the rest. Then we’ll look at the stairwell camera.”

  Rizzoli moved closer until she stood right behind the charge nurse.

  On the screen, the images backed up, and the elevator door slid shut. Moore pressed Play and the door opened again. Eleven people stepped out, moving like a multilegged organism in their hurry to reach the code. Rizzoli saw urgency in their faces, and even without sound the sense of crisis was obvious. That knot of people vanished to the left of the screen. The elevator door closed. A moment passed, and the door re-opened, discharging another gush of personnel. Rizzoli counted thirteen passengers. So far a total of twenty-four people had arrived on the floor in under three minutes—and that was just by elevator. How many more had arrived by the stairwell? Rizzoli watched with growing amazement. The timing had been flawless. Calling a Code Blue was like setting off a stampede. With dozens of personnel from all over the hospital converging on 5 West, anyone wearing a white coat could slip in unnoticed. The unsub would no doubt stand in the back of the elevator, behind everyone else. He would be careful to keep another person between him and the camera. They were up against someone who knew exactly how a hospital functioned.

  She watched the second group of elevator passengers move off the screen. Two of the faces had remained hidden throughout.

  Now Moore switched tapes, and the view changed. They were looking at the stairwell door. For a moment nothing happened. Then the door swung open, and a man in a white coat came barreling through.

  “I know him. That’s Mark Noble, one of the interns,” said Sharon.

  Rizzoli took out her spiral notebook and jotted down the name.

  The door flew open again, and two women emerged, both in white uniforms.

  “That’s Veronica Tam,” said the charge nurse, pointing to the shorter of the pair. “She works on Five West. She was on break when the code was called.”

  “And the other woman?”

  “I don’t know. You can’t see her face very well.”

  Rizzoli wrote down:

  10:48, stairwell camera:

  Veronica Tam, nurse, 5 West.

  Unknown female, black hair, lab coat.

  A total of seven people came through the stairwell door. The nurses recognized five of them. So far Rizzoli had counted thirty-one people who’d arrived by either elevator or stairwell. Add to that the personnel already at work on the floor, and they were dealing with at least forty people with access to 5 West.

  “Now watch what happens as people leave during and after the code,” said Moore. “This time they’re not rushing. Maybe you can pick up a few more faces and names.” He fast-forwarded. At the bottom of the screen, the time display advanced eight minutes. The code was still in progress, but already unneeded personnel were beginning to drift away from the ward. The camera caught only their backs as they walked to the stairwell door. First, two male medical students, followed a moment later by a third unidentified man, departing alone. Then there was a long pause, which Moore fast-forwarded through. Next a group of four men exited together into the stairwell. The time was 11:14. By then the code had officially ended, and Herman Gwadowski had been declared dead.

  Moore switched tapes. Once again, they were watching the elevator.

  By the time they’d run through the tapes again, Rizzoli had jotted down three pages of notes, tallying the number of arrivals during the code. Thirteen men and seventeen women had responded to the emergency. Now Rizzoli counted how many were seen leaving after the code ended.

  The numbers did not add up.

  At last Moore pressed Stop, and the screen went blank. They had been staring at the video for over an hour, and the two nurses looked shell-shocked.

  Cutting through the silence, Rizzoli’s voice seemed to startle them both. “Do you have any male employees working on Five West during your shift?” she asked.

  The charge nurse focused on Rizzoli. She seemed surprised that another cop had somehow slipped into the room without her realizing it. “There’s a male nurse who comes on at three. But I have no men during day shift.”

  “And no men were working on Five West at the time the code was called?”

  “There might have been surgical residents on the floor. But no male nurses.”

  “Which residents? Do you remember?”

  “They’re always in and out, making rounds. I don’t keep track of them. We have our own work to do.” The nurse looked at Moore. “We really need to get back to the floor.”

  Moore nodded. “You can go. Thank you.”

  Rizzoli waited until the two nurses had left the room. Then she said to Moore, “The Surgeon was already on the ward. Before the code was even called. Wasn’t he?”

  Moore rose to his feet and went to the VCR. She could see anger in his body language, the way he jerked the tape out of the machine, the way he shoved in the second tape.

  “Thirteen men arrived on Five West. And fourteen men left. There’s an extra man. He had to be there the whole time.”

  Moore pressed Play. The stairwell tape began rolling again.

  “Damn it, Moore. Crowe was in charge of arranging protection. And now we’ve lost our only witness.”

  Still he said nothing but stared at the screen, watching the by-now familiar figures appear and disappear through the stairwell door.

  “This unsub walks through walls,” she said. “He hides in thin air. They had nine nurses working on that floor, and none of them realized he was there. He was with them the whole goddamn time.”

  “That’s one possibility.”

  “So how did he get to that cop? Why would any cop let himself be talked into leaving the patient’s door? Stepping into a supply room?”

  “It would have to be someone he was familiar with. Or someone who posed no threat.”

  And in the excitement of a code, with everyone scrambling to save a life, it would be natural for a hospital employee to turn to the one guy who’s just standing there in the hallway—the cop. Natural to ask that cop to help you with something in the supply room.

  Moore pressed Pause. “There,” he said softly. “I think that’s our man.”

  Rizzoli stared at the screen. It was the lone man who’d walked out the stairwell door early in the code. They could see only his back. He wore a white coat and an O.R. cap. A narrow swath of trimmed brown hair was visible beneath the cap. He had a slender build, his shoulders not at all impressive, his whole posture stooped forward like a walking question mark.

  “This is the only place we see him,” said Moore. “I couldn’t spot him in the elevator footage. And I don’t see him coming up through this stairwell door. But he leaves this way. See how he pushes the door open with his hip, never touching it with his hands? I’m betting he left no prints anywhere. He’s too careful. And see how he hunches over, as though he knows he’s on camera. He knows we’re looking for him.”

  “We got any ID?”

  “None of the nurses can name him.”

  “Shit, he was on their floor.”

  “So were a lot of other people. Everyone
was focused on saving Herman Gwadowski. Everyone except him.”

  Rizzoli approached the video screen, her gaze frozen on that lone figure framed in the white hallway. Though she could not see his face, she felt as chilled as though she were looking into the eyes of evil. Are you the Surgeon?

  “No one remembers seeing him,” said Moore. “No one remembers riding up with him in the elevator. Yet there he is. A ghost, who appears and vanishes at will.”

  “He left eight minutes after the code started,” said Rizzoli, looking at the time on the screen. “There were two medical students who walked out right before him.”

  “Yes, I spoke to them. They had to get to a lecture at eleven. That’s why they left the code early. They didn’t notice our man follow them into the stairwell.”

  “So we have no witnesses at all.”

  “Just this camera.”

  She was still focused on the time. Eight minutes into the code. Eight minutes was a long time. She tried to choreograph it in her head. Walk up to the cop: ten seconds. Talk him into following you a few feet up the hallway, into the supply room: thirty seconds. Cut his throat: ten seconds. Walk out, shut the door, enter Nina Peyton’s room: fifteen seconds. Dispatch the second victim, walk out: thirty seconds. That added up to two minutes, tops. That still left six minutes. What did he use that extra time for? To clean up? There was a lot of blood; he may well have been splattered with it.

  He’d had plenty of time to work with. The nurse’s aide did not discover Nina’s body until ten minutes after the man on that video screen walked out the stairwell door. By then, he could have been a mile away, in his car.

  Such perfect timing. This unsub moves with the accuracy of a Swiss watch.

  Abruptly she sat up straight, the realization zinging through her like a bolt of electricity. “He knew. Jesus, Moore, he knew there’d be a Code Blue.” She looked at him and saw, by his calm reaction, that he had already reached that conclusion. “Did Mr. Gwadowski have any visitors?”

  “The son. But the nurse was in the room the whole time. And she was there when the patient coded.”

  “What happened just prior to the code?”

  “She changed the IV bag. We’ve sent the bag for analysis.”