Code White (3 page)

*   *   *

To be sure, Kevin O’Day had been less wowed by the TV cameras than anyone else in OR 3. He had barely listened while his own brain-child Odin spoke to Kathleen Brown. Instead, his gaze was riveted on his computer monitor, which was blank except for two short lines of type:

SEND PAGE?

YES        NO

A bonehead question, yet Kevin had been pondering it for the past five minutes, if not for most of the morning. He was not normally wishy-washy. But he knew that behind this question lay the biggest showdown of his life, and he had to be sure of his hand. Once sent, the page could not be taken back.

He wished that this question— “Send Page?” —could have been approached logically, using time-tested algorithms of decision analysis.
Here are the benefits, here are the risks, each weighted according to probability and worst-case impact.
He was a natural for that kind of analysis. But this … this was something else. “Send Page?” was not so much a question as a challenge. It said,
Show your manhood. Time to go all in—or fold.
The blue computer screen and its two lines of type were a curtain that divided earthly reality from the world of pure imagination. He had never dared to lift that curtain before. But now …

Oh, if only Odin could have made the decision for him! Odin would not have felt the coldness of sweat upon his brow, the heartburn, the throbbing pulse in his temples.… But Odin was all brain and no backbone. He would have been no help here. There was a reason why poker was the only game he couldn’t master.

Kevin moved his finger back and forth between two keys—“Yes” and “No”—not pressing them, only making feather-light contact, as if some chance vibe off their surface might settle the fateful question. But the longer he played with them this way, the more paralyzed his will became.

He might have gone on forever—until a minuscule incident, no more substantial than the beat of a butterfly’s wings, put everything into focus. He had been checking out the room, a little worried that someone might break free from the spell of the TV cameras long enough to notice what was on his monitor. Suddenly, he glimpsed two green eyes peering at him from behind an ECG display. They were the eyes of a sylphlike, olive-skinned woman—a woman he had loved, even worshipped, for five delirious years. Her look made his blood run cold. He could have withstood anything else—hatred, ridicule, rage, contempt—anything but this. Anything but …
pity
.

And in that instant, the instant of Ali’s pitying him, perfect clarity dawned upon Kevin. “Send Page?” He needed no algorithms of logic. He
felt
the answer. He felt it like the snap of an electric shock sweeping down his nerves, bringing every sinew into action. Instantaneously, as if by conditioned reflex, his pale, cold finger rapped the key:

YES

He blinked, and the two lines of type had vanished from his computer screen.

*   *   *

On television, Ali watched Amy Richmond in the New York studio grilling Dr. Helvelius. “Isn’t it true that not everyone is comfortable with the experiment you’re about to perform?” said the anchor. “In a sense, you’re trying to create a hybrid between a computer and the human mind, between man and machine. What about those dozens of protesters who are picketing your hospital at this very moment? What would you say to those who feel that what you are doing violates the laws of nature, perhaps even the laws of God?”

Helvelius looked as though he had just bitten into a ripe lemon. “All progress generates reaction,” he said. “If by the laws of nature you mean things as they have always been till now, then I would argue that penicillin violates the laws of nature, since the experience of countless centuries proves that man was meant to die from pneumonia and venereal disease. And what could be more unnatural than to cut open a living human body to remove a tumor or a gangrenous appendix? What were we given skin for, if not to hide the mysteries within, and to plant a ‘Do Not Disturb’ sign squarely in the path of the surgeon? Everything that is new begins by being frightening. But given enough time, the so-called laws of nature and of God redefine themselves.”

Do they?
thought Ali.
Are there no limits? No final taboos?
There was something about all this rush to make history that troubled her. Focused on making SIPNI work, she and the rest of the team had never paused to question their own premises. They were not philosophers, after all. Their horizons—or “endpoints,” as they preferred to call them—went no further than the survival of a patient, or a gain of function. They had asked only what
could
be done—not what
ought
to be done.

Back at the New York desk, Amy Richmond put on a pensive look. “Some experts have expressed a fear that this technology could be used to create an artificial superman—by the military, or a multinational corporation, or even by organized crime. What do you say to that?”

Helvelius lowered his head and glared over the top of his glasses. It was a defiant gesture, one that Ali had met with on her first day as a resident, when she had had the naïveté to ask the god of Neurosurgery why he didn’t try to remove a tumor from the skull base of an elderly patient. Ali still smarted from the harangue that followed: Helvelius, bloody scalpel in hand, grilling her, lecturing her on futility, quality of life, false heroics, and the anatomy of the cavernous sinus. That night she had lain sleepless in her bed despising herself, renouncing her dream of becoming a surgeon. But through all her self-pity, a still, soft voice spoke to her:
He’s right. He looks at reality without any trace of sentiment. And if he can do that, I can learn to do it, too.
By the next morning she had not only decided to go on with surgery, she had claimed Helvelius as her personal mentor.

“Th-those are not experts talking!” sputtered Helvelius now. “They are s-s-self-appointed jackdaws who greatly exaggerate what SIPNI is capable of. Our aim is simply to repair the broken bridges of the brain. If we succeed, we can restore function lost to strokes, or spinal cord injuries, or crippling diseases like multiple sclerosis or ALS. Is that not enough in this day and age?”

“But the fear is—”

“Don’t talk to me about people’s namby-pamby fears!” Helvelius’s bushy eyebrows arched, furrowing his brow like the tracings of a seismograph at full tilt. “We’ve had months of discussions about this. Our project has been thoroughly vetted by the Ethics Review Board of this medical center, as well as by the Food and Drug Administration and the National Institutes of Health. Every issue has been examined. There is no rational basis for any fear whatsoever.”

Helvelius waved his hand dismissively. As he did so, he revealed a little-known peculiarity about himself. He was missing the index finger of his right hand. Ali knew that he had lost it many years before on the Minnesota farm where he had grown up. It had almost kept him out of a surgical residency. But he had gone on to prove that he could do more with nine fingers than most surgeons could with ten.

“Let me introduce you to another member of our team,” said Helvelius, pointedly changing the subject. “The SIPNI device could not work without some way to connect it to Jamie’s brain. For that we use a gel with unique conducting properties, which was developed in a laboratory here at Fletcher Memorial by my assistant, Dr. Ali O’Day, who also happens to be Kevin’s wife. I’ll let Ali tell you about the gel.”

Helvelius stepped aside, drawing Ali into the line of view of the camera that had been stationed on the other side of the bed. Ali had known this moment was coming—the assistant director had held a rehearsal the day before—but when she glanced back at the monitor, a fleeting glimpse of her own face on television froze her. Four or five agonizing seconds passed. Through the bright lights she saw Kathleen Brown—her skin unnaturally orange from the heavy makeup used to counteract the blue color bias of the TV cameras, her hair helmetlike in its spray-lacquered perfection. She saw the microphone thrust like a spear toward her face. And she saw the tiny red light of the Betacam, the eye of five million viewers—the eye of an entire country.

What was she supposed to say? Dr. Helvelius had lobbied hard to bring this camera into the operating room. She had tried to want it, because Helvelius had wanted it. But Ali distrusted reporters, particularly where science was concerned. All they were interested in was drama—not science, but a magic show. They had no patience for the rigorous thinking that was at the foundation of a breakthrough like SIPNI. And despite all their fawning and flattery, Ali was sure that they were poised to swoop down like vultures should any part of today’s surgery go wrong.

But five million viewers were waiting. How could she reach them? She took a deep breath, the breath called
deergha shvaasam
in Sanskrit, as she told herself that this was no different from lecturing at grand rounds or presenting cases at tumor boards. But these five million were not doctors. They did not speak her language, the language of science. How could she ever explain to them? She felt as she had when she was seven, in second grade, struggling to speak English when all the words wanted to come out in Masri Arabic.

And worst of all, there was the camera’s unblinking eye—the relentless eye of millions, watching her discomfort without a trace of compassion.

Ali felt another wave of nausea.
Oh, God, what if I threw up now, in front of all the world?
She began to speak, her voice sounding small and unconvincing in her ears. “SIPNI’s input and output to the brain passes through what we call the terminal plate, which is really the outer covering—or shell, if you will—of this egg-shaped device.” She felt a tiny joy at the word “shell,” which seemed to reinforce the egg shape she wanted her listeners to see in their minds.
Perhaps I can reach them after all
.

“This surface, a little more than two square inches, is studded with over twelve million separate contact points, too small to be seen with the naked eye. The trick is to get each of these contacts to line up exactly with one of the countless fibers that stretch back and forth between different parts of the brain. We call these axons.”
Oh, God! Axons? I’m going to lose them here. How can I get them to see this?
“Axons … axons are like … fine sprouts issuing directly from individual brain cells. They can be from a thousandth of an inch to several inches long, depending on what parts of the brain need to talk to each other. It would be impossible for us to reconnect them one by one, by hand. That is the function of CHARM. When—”

She opened her mouth to go on, then skipped back like a record player needle jumping its groove. “Uh, CHARM stands for Current-Sensitive Heuristic Axon-Redirecting Matrix. It’s the gel that we apply to the outer surface of SIPNI.” She silently castigated herself, not only for the skip, but for using the lifeless word “surface” instead of the joyful word “shell.”

The red light of the camera held its unblinking stare. “The gel lets SIPNI grow its own connections. When first applied, the gel is only a slight conductor of electricity. But it has a very special property such that, each time a tiny spark of current passes through it—wherever SIPNI finds an axon, or the axon talks back—that part of the gel undergoes a chemical reaction that makes it a much better conductor. The next time, the connection gets faster and stronger, until a minute pathway is formed, less than a hundredth of the diameter of a human hair. SIPNI keeps sweeping the area with electrical pulses, searching for all the axons within reach. As pathways are formed, the chemical reaction releases a neural growth factor impregnated into the gel, which causes the axons to grow into the gel. Eventually, the gel solidifies, forming a sieve of high-conducting nanotubes, which are filled by axon terminals, like cables inserted into the holes of an old telephone switchboard. After that, the connections are permanent.”

Oh, what a mess she was making of this!
Neural growth factors, nanotubes, axon terminals …
She had rushed through them all, impetuously, as one runs toward the light at the end of a dark tunnel. Had she lost her viewers completely?
Deergha shvaasam. Deergha shvaasam
. Whether she had done well or ill, this was live television. There was no going back.

*   *   *

Harry Lewton, the newly hired chief security officer, watched the struggles of Ali O’Day on the middle screen of a long row of TV monitors in his office. In his right hand he held a mug of coffee still too hot to drink, while in his left he held a phone receiver to his ear, propping his elbow on a pile of security status reports from the night before. His inlaid tan caiman-skin boots were balanced on a plastic wastebasket, rocking it precariously on one edge.

He was speaking to a nurse on the general medical ward on the eighteenth floor of Tower C.

“That’s Viola Lewton, spelled V-I-O-L-A,” he said. “I brought her in yesterday. Aspiration pneumonia is what they said it was.”

“Your mother? Yes, I know her. She had a pretty rough night of it, but she’s finally sleeping now. It’d be a shame to disturb her. I can have her call you when she wakes up.”

“Fine. Will you personally see to it that she gets her Parkinson’s medicine? She needs to take it three times a day. Without it, she has trouble speaking or eating.”

“Yes, of course, Mr. Lewton. It’s right here in her chart. Someone underlined it and wrote exclamation marks.”

“That was me.”

Harry’s mother was only fifty-eight, but she had had Parkinson’s disease for the past six years and it had made her as decrepit as an eighty-five-year-old. It wasn’t just the tremors, which were one of the easiest things to control with medication, but she lived in a slow-motion world, her every movement requiring painful deliberation. Her body was becoming a prison. She had had to give up her career driving a school bus, and now she had gone so far downhill that she could hardly feed herself, much less cook or bathe or button a blouse.

She had never known anything but Texas and Louisiana until three weeks ago, when Harry had pulled her out of a nursing home and brought her to live with him in his apartment in Chicago. That was like firing on Fort Sumter as far as Harry’s family was concerned. His sister, Luanne, had put her in the home, and she insisted that it was the only safe place for her to be. But for Harry, turning his mother over to the care of strangers was desertion. So he had flown down to Houston, brandished his power of attorney, and taken her himself.