Stieg Larsson: The Girl Who Kicked The Hornets’ Nest

But that was not his concern. His job was to save his patient’s life, irrespective of whether she was a triple murderer or a Nobel Prize winner. Or both.

Then the efficient chaos, the same in every A.&E. the world over, erupted. The staff on Jonasson’s shift set about their appointed tasks. Salander’s clothes were cut away. A nurse reported on her blood pressure – 100/70 – while the doctor put his stethoscope to her chest and listened to her heartbeat. It was surprisingly regular, but her breathing was not quite normal.

Jonasson did not hesitate to classify Salander’s condition as critical. The wounds in her shoulder and hip could wait until later with a compress on each, or even with the duct tape that some inspired soul had applied. What mattered was her head. Jonasson ordered tomography with the new and improved C.T. scanner that the hospital had lately acquired.

Dr Anders Jonasson was blond and blue-eyed, originally from Umeå in northern Sweden. He had worked at Sahlgrenska and Eastern hospitals for twenty years, by turns as researcher, pathologist, and in A.&E. He had achieved something that astonished his colleagues and made the rest of the medical staff proud to work with him; he had vowed that no patient would die on his shift, and in some miraculous way he had indeed managed to hold the mortality rate at zero. Some of his patients had died, of course, but it was always during subsequent treatment or for completely different reasons that had nothing to do with his interventions.

He had a view of medicine that was at times unorthodox. He thought doctors often drew conclusions that they could not substantiate. This meant that they gave up far too easily; alternatively they spent too much time at the acute stage trying to work out exactly what was wrong with the patient so as to decide on the right treatment. This was correct procedure, of course. The problem was that the patient was in danger of dying while the doctor was still doing his thinking.

But Jonasson had never before had a patient with a bullet in her skull. Most likely he would need a brain surgeon. He had all the theoretical knowledge required to make an incursion into the brain, but he did not by any means consider himself a brain surgeon. He felt inadequate but all of a sudden realized that he might be luckier than he deserved. Before he scrubbed up and put on his operating clothes he sent for Nurse Nicander.

“There’s an American professor from Boston called Frank Ellis, working at the Karolinska hospital in Stockholm. He happens to be in Göteborg tonight, staying at the Radisson on Avenyn. He just gave a lecture on brain research. He’s a good friend of mine. Could you get the number?”

While Jonasson was still waiting for the X-rays, Nurse Nicander came back with the number of the Radisson. Jonasson picked up the telephone. The night porter at the Radisson was very reluctant to wake a guest at that time of night and Jonasson had to come up with a few choice phrases about the critical nature of the situation before his call was put through.

“Good morning, Frank,” Jonasson said when the call was finally answered. “It’s Anders. Do you feel like coming over to Sahlgrenska to help out in a brain op.?”

“Are you bullshitting me?” Ellis had lived in Sweden for many years and was fluent in Swedish – albeit with an American accent – but when Jonasson spoke to him in Swedish, Ellis always replied in his mother tongue.

“I’m sorry I missed your lecture, Frank, but I hoped you might be able to give me private lessons. I’ve got a young woman here who’s been shot in the head. Entry wound just above the left ear. I badly need a second opinion, and I don’t know of a better person to ask.”

“So it’s serious?” Ellis sat up and swung his feet out of bed. He rubbed his eyes.

“She’s mid-twenties, entry wound, no exit.”

“And she’s alive?”

“Weak but regular pulse, less regular breathing, blood pressure is 100/70. She also has a bullet wound in her shoulder and another in her hip. But I know how to handle those two.”

“Sounds promising,” Ellis said.

“Promising?”

“If somebody has a bullet in their head and they’re still alive, that points to hopeful.”

“I understand… Frank, can you help me out?”

“I spent the evening in the company of good friends, Anders. I got to bed at 1.00 and no doubt I have an impressive blood alcohol content.”

“I’ll make the decisions and do the surgery. But I need somebody to tell me if I’m doing anything stupid. Even a falling-down drunk Professor Ellis is several classes better than I could ever be when it comes to assessing brain damage.”

“O.K. I’ll come. But you’re going to owe me one.”

“I’ll have a taxi waiting outside by the time you get down to the lobby. The driver will know where to drop you, and Nurse Nicander will be there to meet you and get you kitted out.”

Ellis had raven-black hair with a touch of grey, and a dark five-o’clock shadow. He looked like a bit player in E.R . The tone of his muscles testified to the fact that he spent a number of hours each week at the gym. He pushed up his glasses and scratched the back of his neck. He focused his gaze on the computer screen, which showed every nook and cranny of the patient Salander’s brain.

Ellis liked living in Sweden. He had first come as an exchange researcher in the late ’70s and stayed for two years. Then he came back regularly, until one day he was offered a permanent position at the Karolinska in Stockholm. By that time he had won an international reputation.

He had first met Jonasson at a seminar in Stockholm fourteen years earlier and discovered that they were both fly-fishing enthusiasts. They had kept in touch and had gone on fishing trips to Norway and elsewhere. But they had never worked together.

“I’m sorry for chasing you down, but…”

“Not a problem.” Ellis gave a dismissive wave. “But it’ll cost you a bottle of Cragganmore the next time we go fishing.”

“O.K., that’s a fee I’ll gladly pay.”

“I had a patient a number of years ago, in Boston – I wrote about the case in the New England Journal of Medicine . It was a girl the same age as your patient here. She was walking to the university when someone shot her with a crossbow. The arrow entered at the outside edge of her left eyebrow and went straight through her head, exiting from almost the middle of the back of her neck.”

“And she survived?”

“She looked like nothing on earth when she came in. We cut off the arrow shaft and put her head in a C.T. scanner. The arrow went straight through her brain. By all known reckoning she should have been dead, or at least suffered such massive trauma that she would have been in a coma.”

“And what was her condition?”

“She was conscious the whole time. Not only that; she was terribly frightened, of course, but she was completely rational. Her only problem was that she had an arrow through her skull.”

“What did you do?”

“Well, I got the forceps and pulled out the arrow and bandaged the wounds. More or less.”

“And she lived to tell the tale?”

“Obviously her condition was critical, but the fact is we could have sent her home the same day. I’ve seldom had a healthier patient.”

Jonasson wondered whether Ellis was pulling his leg.

“On the other hand,” Ellis went on, “I had a 42-year-old patient in Stockholm some years ago who banged his head on a windowsill. He began to feel sick immediately and was taken by ambulance to A.&E. When I got to him he was unconscious. He had a small bump and a very slight bruise. But he never regained consciousness and died after nine days in intensive care. To this day I have no idea why he died. In the autopsy report, we wrote brain haemorrhage resulting from an accident, but not one of us was satisfied with that assessment. The bleeding was so minor and located in an area that shouldn’t have affected anything else at all. And yet his liver, kidneys, heart and lungs shut down one after the other. The older I get, the more I think it’s like a game of roulette. I don’t believe we’ll ever figure out precisely how the brain works.” He tapped on the screen with a pen. “What do you intend to do?”