Jerry Labriola - Murders at Hollings General

Dr. David Brooks remembered the man behind the surgical mask as shorter and left-handed.

"Strange," he whispered, turning to Dr. William Castleman, the young Director of Emergency Medicine, "back in the Navy, he was a little man. They used to give him a stool to stand on when he operated."

"Maybe it was years of military food," Castleman said, straightening his starched white jacket. "Gave him a growth spurt."

"Sure, and made him ambidextrous." David had removed his blue blazer and placed it across his knees, half again higher than Castleman's.

They sat together in the center of the first row overlooking Suite 7, the surgical amphitheater of Connecticut's venerable Hollings General Teaching Hospital, on a viewing balcony crowded with doctors, nurses, medical students, administrators and news reporters. Frozen forward, eyes homed in on the operating surgeon, their breathing stalled for a collective silence. Before them, bright lights reflected off an otherwise invisible glass partition. On the wall, a clock's second hand cogwheeled to precisely three thirty. The balcony smelled scrubbed and antiseptic.

David asked himself whether he remembered wrong.

Poised to the left of the operating table, its occupant intubated and asleep, the surgeon drummed his latex fingers on the patient's chest awaiting a scalpel to be snapped into his right hand. An anesthesiologist guarded the head of the table while three other physicians were positioned to the right of the body, including the hospital's Chief of Surgery and the Associate Chief. Six nurses bustled among the instruments, lights and monitors. An electrocardio-graphic tracing showed the rhythmical complexes of the patient's heart.

A rotund nurse broke from the pack and like a hydroplane, glided off to the side. A wisp of chalky hair strayed from her constrictive cap. She eyed the operative field and spoke into a microphone attached to her surgical gown. "Ladies and gentlemen, I'm Virginia Baldwin, the Nursing Supervisor of our Surgical Department. We're indeed honored to have Dr. Raphael Cortez here with us today. He's about to make his initial abdominal incision and the pancreatic transplantation will begin. I'd like to inform you-especially those of you from the media-that the patient is Mr. Charles Bugles, the Board Chairman of this hospital. I mention it because somehow I think it's fitting that he should be the first to receive an organ through the transplantation program here at Hollings General. I'll come back to you every so often during the procedure, but I'll leave the microphone on. It's pretty sensitive and you may pick up instructive interplay here. Dr. Cortez, please feel free to explain anything-anything at all. I'm sure our students would be very appreciative." From a speaker above the viewing balcony, her words resonated against the drone of the patient's monitored heartbeat.

Castleman stretched up and cupped his hand around David's ear. "Doesn't a doctor like Cortez deserve prime time-like eight in the morning? Why three-thirty?"

David cupped back, "He may be famous, but he's just a visiting dignitary. Remember, it's his first case here. Anyway, who would they bump? Friedman? Scully? Matthews?" He tweaked his floppy mustache which was as wide as his bow tie. "There'd be mutiny," he added, flashing his thin linear smile, not the curved one-happy and pronounced-when only central incisors would show, their companions retracting out of sight, his skin florid.

"You kept in touch with the guy?" Castleman asked.

"Only with Christmas cards."

"Have you seen him since he arrived?"

David considered before answering. "No, I haven't had a chance yet. I understand the Credentials Committee acted on him. I don't think anyone's met him except them-and maybe they just looked at his photo."

The surgeon made the initial transverse incision with a flair. Nurse Baldwin announced, "Here we go"

Castleman leaned closer to David. "Did he do any transplants when you were in the Navy?"

"Not really-except on animals. But, he was always experimenting. Then after I left, he started with pancreas trials while everybody else around the country was doing hearts and lungs and kidneys. I guess you'd say he's a pioneer in pancreatic replacements."

David pushed down on his feet, leveraging his six-five frame for a better view of the surgery forty feet away. He saw the surgeon's eyes flit over the abdominal cavity, toward his assistants and back. They tugged on retractors and applied internal sutures while a nurse dabbed the surgeon's forehead.

Two minutes into the operation, the Chief screamed, "No, not there, Doctor!" Blood spurted against the palm of his gloved hand. "What are you doing? Where are you cutting? "

The anesthesiologist said calmly, "Pressure dropping-eighty over forty."

The Chief said, "Christ, let me get in there!" He ran around to the left of the table and tried to muscle aside the operating surgeon.

"Get back to your position, Doctor! You may be Chief, but I'm in charge of this case. Open the blood drip to full. Get four more units ready."

David jumped up and pressed his hands and face against the glass partition. He saw blood well up in the patient's abdomen and heard the beep become thready. Then, there was a continuous hum, the kind that had torn through his stomach too many times before. Castleman bit his knuckle.

"More sponges!" the Associate Chief shouted. "Ligate above. Ligate above!"

"I can't see. Suction. Suction, damn it! How can I ligate if I can't see?"

"Then feel. Son-of-a-bitch, feel!"

"Can't get a pressure!" the anesthesiologist cried. "Forget the drip-pump the blood in. And push in a pressor."

Five seconds later, David stared at a straight line on the heart monitor. "Oh, my God!" he said and felt his own blood drain from his face as he regarded Castleman. "And I arranged for Bugles' surgery myself. Cortez. He's supposed to be the best in the world at this thing." He spoke as if wounded by his own words.

David looked back down. Personnel poured in from adjoining rooms. Faces contorted. The suite swelled into chaos. Babble vibrated from the overhead speaker.

"Get more suction going-hurry up!"

"Pressors-pressors-and more blood!"

"Move over, move over!"

"Hundred percent oxygen!"

"Trendelenberg-get him in Trendelenberg position!"

"He's in it, damn it!"

"Run the blood in-run it in, c'mon!"

One doctor injected medication into the patient's heart. Others packed sponges tightly around tubes straining to suction from the operative site.

David wondered aloud: "Did he cut through the aorta?" He answered his own question. "But, there'd be blood on the ceiling. No, maybe a renal artery. Or more." The heart tracing remained flat.

David searched the room for the lead surgeon. He had vanished.

"I'm going down through the lockers. Bill, you go straight down. See if we can head off Cortez."

David scrambled from the row of wide-eyed, muted onlookers and had to duck as he bolted out a back door, down a flight of steps and into the afternoon quiet of the surgeons' dressing area, on his way to the operating suites on the second floor. He stumbled among the rows of lockers, pushing the pace beyond the usual for this behemoth who now felt more cut out for sleuthing than medicine, instantly obliged to trace a murderer instead of a runaway teenager. Deep in the green interstices, David stopped abruptly when he came upon a small man draped over the bench before an open locker. He was in street clothes and motionless.

David turned the body over and recoiled at the sight of a pearl dagger handle protruding at an upward angle from the man's left chest.