Rupture Page 15

  Landers looked scared but excited.

  “This is what it’s all about,” Eli said.

  With a quick nod, Landers confirmed his allegiance.

  Susan said, “Let’s do it.”

  The next seven minutes was a combination of surgical finesse and brute force. The spleen lay in the left upper abdomen like a cracked sponge submerged in a tub. The splenic artery pumped blood into the organ and it spouted like a broken water main. Recalling the anatomy from hundreds of cases before, Eli navigated into the left upper quadrant as though on automatic pilot, blind hands moving in a crimson sea.

  Eli found the spleen’s vascular inflow and clamped across both artery and vein. Susan pulled out two large chunks of pulverized spleen and dropped them into a metal basin that Landers held for this purpose. But the space previously occupied by the spleen now filled with blood that spilled from the cracked liver.

  The anesthesiologist looked over the drapes. “I’ve given nineteen units of packed cells and his pressure’s barely holding.”

  They had replaced practically the boy’s entire blood volume. Eli pointed to the cut edge of Tynes’s skin and subcutaneous tissue. Small vessels that would normally have constricted with clot were open and oozing freely.

  “Give him platelets and fresh frozen plasma,” Eli told the anesthesiologist. “And start packing him for the ICU.”

  Eli placed his hand over the smooth surface of the liver, but then, as though slipping from the edge of a cliff, his hand plunged into the center of the right hepatic lobe through a crack that had split the organ in half. It would be impossible to repair the laceration and, unlike the spleen, the liver was essential to life.

  They placed sponge packs into the cracked organ, counting each one that would be removed in reverse order two days later. The first dozen pads were as effective as Kleenex to mop up a flooded basement. But the second dozen began to compress the open venous channels, and a modicum of hemorrhagic control was achieved.

  “Excuse me, Dr. Branch,” the circulating nurse said, interrupting the closure. “There’s a phone call for you.”

  “Take a message, please. I can’t talk now.”

  They continued to close Scott Tynes’s abdomen, pulling the abdominal wall over loops of swollen bowel. Eli forgot the phone call.

  “Dr. Branch?”

  Eli could sense the hesitation in her voice.

  “You won’t believe who’s on the phone.”

  A bad time for another interruption.

  “Who? Who is it?”

  “A reporter from Channel Four news. She wants to know the condition of Mr. Tynes.”

  The phone lines to each operating room were private, to be used only by operating room personnel for the care of patients. If someone asked the hospital operator for the OR, they would be questioned for identity, then forwarded to the front desk. Even a call from family or friends would not make it into the operating room unless there was an emergency. Certainly, never a call from the press.

  “You’re kidding.” Eli said.

  The nurse shook her head and blocked the receiver with her hand. “It’s Shontay Williams, from Channel Four. Says she knows you?”

  “This is way out of line,” Eli blurted. “I’ve not even had the chance to tell this boy’s family.” Eli thrust his hand down as if he was hanging up the phone. “Just hang up. Do it.”

  The nurse hesitated and pointed to the phone.

  “But it’s . . .”

  “Hold this.” Eli handed the needle driver to Landers. With a bloody glove, he grabbed the receiver from the nurse, and slammed it on the hook.

  CHAPTER TWENTY-EIGHT

  DOWNTOWN MEMPHIS

  6:30 P.M.

  The Mid-South Forensics Laboratory occupied an abandoned warehouse on the north end of Third Street. From outside, it looked like a concrete fortress, with steel bars reinforcing the windows and doors. But what it lacked in outward charm was more than compensated for by an elaborate diagnostic facility on its second and third floors. In an effort to combat the region’s surplus of violent crimes, a tristate commission from Mississippi, Arkansas, and Tennessee appropriated generous funds to acquire state-of-the-art forensic equipment and technology from DNA testing to entomologic analysis and ballistics. At the completion of the spending spree, Mid-South was way over budget. No funds were left to support the laboratory personnel. After the lab director resigned, only one person was left behind to handle all the work.

  Basetti pushed back in a reclining office chair and stared at his new title: Interim Director of Forensic Investigation. He didn’t care that it was written on a wide piece of bandage tape and stuck to his coat. He still thought it was cooler than hell.

  Since he was the lab’s only occupant, he was free to choose both the musical selection and the lighting. Nine Inch Nails tested the capacity of two desk PC speakers, and eerie light from a black lamp reflected off police tape strung from the ceiling like an orb spider’s web.

  But tonight, there was work to do in the form of a single plate of cultured cells that Basetti had removed from the facility’s incubator and placed on the bench top. He had already analyzed what little trace evidence was found at the Branch Laboratory crime scene, as it was now officially called. A sample of foreign DNA found on Vera Tuck’s body was being amplified by PCR, with the final results still a day or two away. These were all standard procedural skills that the interim director had acquired during a summer lab internship at the medical school. A year later, while obtaining his degree in forensic science, he learned how to apply these skills to actual criminal investigation.

  But what the hell am I supposed to do with a dish of human cells? Basetti wondered.

  The cells had been obtained as the primary evidence at the crime scene, pried from the hand of the victim exactly nine hours earlier. Now it was up to Basetti to figure out why they were worth killing for.

  He slid the cells under the microscope. At 10X view, the cuboidal cells formed a monolayer, all snuggled together in colonies. “Well, how cute,” Basetti said. To magnify the view, he changed the lens to 40X. But he flipped the wrong switch and activated the fluorescence microscope.

  “Whoa!” A green glow emanated from the dish. He focused on individual cells, each shape sharply outlined by a flash of fluorescent green pigment.

  At the top of the staircase, Detective Frank Lipsky rattled the door of the second-floor laboratory. Loud music pulsed through the wood as if from a freshman dorm. Lipsky removed a ring of keys from his pocket, selected the one he thought would work, and entered the lab.

  He stopped to let his eyes adjust to the darkness. Basetti was seated at the microscope, his back to him. Lipsky tiptoed around the central desk, past a set of upright freezers.

  “What you looking at?”

  The desk, the scope, and Basetti’s body shook with deep riveting jolts. The interim director had half-climbed onto the table when he turned around.

  “Damn, can’t you knock?”

  “I could’ve come in on a bulldozer and you would’ve never heard it. Turn that shit down.”

  Basetti reached for the speaker. “I swear, trying to get some work done and you pull something like this.”

  Lipsky raised himself up and sat on the bench. “Figured I’d find your nose in some girly magazine.”

  Basetti gave him a disgusted look and pointed to his taped-on name tag.

  “Oh, I forgot, Mr. Forensic Directorship,” Lipsky mocked. “You’re so above that now.”

  Basetti was back at the scope, his full attention on the cells.

  Lipksy admired the yellow tape streamers along the ceiling. “Like what you’ve done with the place, Martha.”

  The technician-turned-director remained silent.

  “Can you at least turn on some lights? This place creeps me out.”

  “Take a look at these cells first,” Basetti said.

  “Cells?”

  “What we took off that old lady in the doc’s lab.”
/>
  Lispky bent over the scope. He misjudged the distance and banged his nose on the view piece. After a series of expletives, he said, “Are they frog cells?”

  “What?”

  “I said, are they frog cells?”

  “What the hell are you talking about?”

  “They’re green, aren’t they?” Lipsky said proudly. “I cut open a frog or two in science class myself.”

  Basetti shook his head. “I bet you then dipped them in batter and fried’em up.”

  “Matter of fact I did, asshole.”

  Basetti stared at him. “Stick to firearms, will you. This is my territory.”

  The detective formed his hand like a gun and pointed at Basetti’s crotch. “You going to tell me about that green puke or not?”

  Basetti turned on the desk lamp and faced Lipsky. “It’s called green fluorescent protein, or GFP. Scientists insert the gene into cells and then the cells make the protein. It’s a method to track cellular movement within the body. You don’t know it’s there unless you use a fluorescent microscope or a lamp, like this.” He picked up an instrument that resembled a large magnifying glass. It flickered on and the green color illuminated again when Basetti held the lamp over the dish.

  Lipsky seemed to be taking it all in.

  “Maybe,” Basetti continued, “just maybe, some of this spilled on whoever killed Vera Tuck.”

  Lipsky looked uncharacteristically serious. “You know, we had a guy just like you in high school,” he said. “Wore these thick glasses with a band of white tape in the middle. Poor kid got so many wedgies, he just stopped wearing underpants.”

  “Screw you.”

  Lipsky took the fluorescent lamp from Basetti. “So this’ll be easy,” he said as he waved it across Basetti like an airport metal detector. “I’ll just take this light here,” his voice becoming louder, “and shine it on every Tom, Dick, and Larry in a hundred-mile radius.”

  “Look. I came up with the clue. The rest is up to you.” Basetti tapped on Lipsky’s chest and said, “That’s why your badge says Detective.”

  CHAPTER TWENTY-NINE

  GATES MEMORIAL HOSPITAL

  6:41 P.M.

  The Tynes family huddled in a small room reserved for private discussions between family and surgeon. Good news could be delivered.

  We got all the tumor out.

  The heart bypass was successful.

  Expect a full recovery.

  Not today.

  There must have been at least ten people in the room, all holding one another. Eli took a quick survey through the glass door before they noticed his approach. Four teenagers sat cross-legged on the floor. Three adults were standing to the side of a couch, in the center of which sat the mother and father, who faced each other in embrace. The mother’s head was bowed and rested on the man’s shoulder.

  In surgical residency, Eli had been singled out for his communication skills. He was asked to teach the third-year surgical clerkship students how to establish a doctor-patient relationship, one that would last beyond the acute illness. Eli found it hard to impart a coherent methodology. Relationships could not be reduced to a number of steps to follow. For him, the relationship with patients and their families started with a basic level of trust, one founded on the tenet that as their physician, he would do everything in his power to heal and relieve suffering. Often, this foundation was formed upon the subtle revelation that Eli, the doctor, was also a son, a brother, a friend, and had carried similar fears, experienced great sorrow, but still maintained at least a glimmer of hope for the future. But no level of training or savvy communication skills could prepare him for a room filled with family about to hear devastating news of their loved one.

  Once before, as a third-year resident on trauma surgery, it had been his responsibility to inform whoever was waiting of the death of a gang member who had been dropped off outside the ER, riddled with bullets. When the young man died on the operating table at two A.M., Eli stood in a pool of blood, exhausted and bewildered at the senseless loss of young life. He entered the conference room, similar to the one before him now, and told those waiting that he was sorry, that the boy had died.

  They did all they could do.

  But on hearing of the boy’s death, his “friends” barricaded the door and demanded, with wailed threats and bashing against the wall, that Eli bring him back to life. Eli had gone in alone, unaware of the danger. He was held hostage for a full five minutes, pleading that no one could have done anything more, and hoping that no weapons had escaped the metal detectors downstairs. The hospital police eventually arrived, knocked down the door, and escorted the gang members from the building.

  Standing now, just outside the door, Eli quickly outlined how he would deliver the news. Laying some crepe, they called it in residency, preparing the family of a critically ill patient for what was inevitable. He would allude to the possibility of head injury, but assure them that confirming tests were yet to be done. This would warn them without removing all hope.

  The family was watching him now, their eyes pulling at him to enter the room and tell them everything was going to be fine. Although Eli knew this would be a totally different scene from that with the gang members, for a moment he though it might be worse.

  Roger Tynes stood and extended his hand. He was middle-aged, with a deep-bored tan, a blue blazer over a white golf shirt. There was no excessive jewelry or fancy watch. Eli was impressed that the man felt no need to display overtly his Fortune 500 wealth. Scott’s mother remained seated and partially hidden behind a tissue, her face blotched with red.

  “Hello, everyone. I’m Dr. Branch.”

  “How’s Scott?” one of the teenage boys blurted out. He had his arms crossed and his chest puffed out.

  Roger Tynes held up his hand toward his younger son and said, calmly, “Let the doctor tell us, Mark.”

  Now it was all Eli. He wished he had asked the hospital chaplain to accompany him for support. But before Eli could speak, a soft trembling voice asked, “Is my son alive?” Mr. Tynes resumed his seat beside his wife and held her.

  “Yes, ma’am, Scott is alive.”

  There was a shifting of the room, as though a valve had been opened to release an explosive pressure. Mrs. Tynes’s expression did not change, however. Her gaze remained fixed on Eli.

  “But he’s in critical condition.”

  “What do you mean, critical condition?” Mark blurted.

  “He has internal injuries to his spleen and liver. We just finished surgery to control the bleeding.”

  “So you stopped it. He’s going to be okay?”

  Eli nodded to Mark but tried to direct his comments to Scott’s parents.

  “We removed his spleen, but his liver was injured so badly that we had to pack towels around it and take him to the intensive care unit.” As he said this, Eli realized that his choice of words—packs, towels—was confusing to them. But Scott’s mother could see past this and voiced the most important point.

  “Scott wasn’t wearing a helmet, was he?”

  “No,” Eli said. “We’re very concerned about a head injury. I’m sorry to tell you, but it could be very serious.”

  Eli’s beeper went off and shattered the morbid silence. It was the ICU. Almost certainly, Scott Tynes was crashing.

  Roger Tynes stood again. He took Eli’s hand with both of his own. “We have every faith in you, Dr. Branch. Scott’s a very special boy. We know that you will take good care of him.”

  Upon hearing those words, Eli knew that his laying of crepe had been ineffective. He also knew that Roger Tynes expected him to be the physician in constant communication with the family.

  Here I am. I’ve lost my job but still had to take one more night of trauma call, the very night that the son of one of the wealthiest men in Memphis would have a near-fatal accident. Eli thought of the multiple reoperations Scott Tynes would require if he lived—a tracheostomy, weeks of intensive care, possibly months.How can I say to R
oger Tynes, Oh yeah, I won’t be taking care of your son after tonight.

  It was Scott’s mother who drove the final nail.

  “God bless you, doctor.”

  Eli held his beeper and said, “I have to go now.” But as he turned, another question was asked. This time from one of the teenaged girls. She was crying.

  “How is Marisa?”

  Eli searched the faces of the other family members. “I’m sorry, who?”

  Mark answered for her.

  “Scott’s girlfriend. She was riding on the back.”

  From the scene of the accident on I-55, twenty minutes after the BK-117 twin-engine helicopter had departed with Scott Tynes, an ambulance pulled away and entered the interstate, traveling five miles per hour under the speed limit.

  No lights, no siren.

  In the back, a sheet covered the body and face of a young woman. She carried no identification, too young for a driver’s license. She had been found in the rubble of the construction site by a state trooper as he collected parts of the broken motorcycle. The first responders on the scene saw no indication of a passenger on the motorcycle. The trooper determined that she was thrown twenty yards on the other side of the concrete divider.

  Dead at the scene.

  At the same moment Scott Tynes was being whisked away to the operating room, the second ambulance backed up to the emergency entrance of Gates Memorial. The paramedics chose to transport the girl to the same hospital, where a determination of her injuries might facilitate the treatment of the surviving victim. Also to facilitate identification of the deceased.

  The body of Marisa Svengoli was wheeled into the trauma bay, where a resident and ER attending confirmed that she was dead. The nurse removed her jean shorts and sleeveless blouse, which was tied in a knot above her navel. She was wearing no shoes. The resident completed a brief examination of her injuries.

  A deep vertical gash along the back of her skull was embedded in thick blonde hair. Her neck had been broken upon impact. But what the doctor found remarkable was the absence of visible injuries to her body, especially given the ejection and impact among the metal implements and concrete at the interstate’s construction site.