Code Whiteby Scott Britz-Cunningham
Ali O'Day, a dedicated young neurosurgeon, might have a Nobel Prize in her futureif she can survive the next eleven hours.
Under the glare of live television camerasand with her lover, Dr. Richard Helvelius, and her estranged husband, Kevin, both looking onAli is about to implant a revolutionary mini-computer into the brain of a blind boy. If it
Ali O'Day, a dedicated young neurosurgeon, might have a Nobel Prize in her futureif she can survive the next eleven hours.
Under the glare of live television camerasand with her lover, Dr. Richard Helvelius, and her estranged husband, Kevin, both looking onAli is about to implant a revolutionary mini-computer into the brain of a blind boy. If it works, he will see again. But someone wants to stop her triumph. No sooner has she begun to operate than the hospital pagers crackle with the chilling announcement, "CODE WHITE." A bomb has been found in the medical center.
But this is no ordinary bomband no ordinary bomber. As minutes tick off toward the deadline, Ali suspects that a vast, inhuman intellect lies behind the plotand that she herself may be the true ransom demand, in Code White by Scott Britz-Cunningham.
“Scott Britz-Cunningham has crafted a sharp, engaging thriller that captures the heart of hospital medicine and absolutely nails the frenetic energy that comes with trying to care for severely ill patients without killing them. Code White is great stuff--one of the most original medical thrillers I've read in a long time.” Michael Palmer, New York Times bestselling author
“Talk about a ticking clock propelling a story--this one's in overdrive.... What a heart-thumping ride. Scott Britz-Cunningham is a welcome addition to the thriller genre.” Steve Berry, New York Times bestselling author
- Tom Doherty Associates
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- First Edition
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Read an Excerpt
By Scott Britz-Cunningham
Forge BooksCopyright © 2013 Scott Britz-Cunningham
All right reserved.
The Huns had taken the citadel of Neurosurgery I. For the rightful denizens of the operating suite—the scrub nurses, anesthetists, residents, postgraduate fellows, and technicians—it was an invasion, a desecration of the Holiest of Holies. Not once in the ten years of its existence had this quiet cluster of green-tiled rooms been so jarred and trampled as now, by this troop of camera operators, lighting men, gaffers, grips, and gofers, bustling back and forth between the scrub room and Operating Room Three. Masquerade as they might in blue scrubs and gowns, shower caps and paper booties, it was obvious that not one of them knew the rules—what could or could not be touched, or where the sterile fields began. They were like monkeys swinging from the glass trellises of a chemistry lab. It was an invitation to disaster.
So thought Ali O’Day, Assistant Professor Neurosurgery, as she looked through the large picture window above the scrub sink while she rubbed a foamy antiseptic brush between her fingers and over her arms up to the elbows. With a mixture of disdain, curiosity, and envy, she watched the film crew hovering about Kathleen Brown, the network’s field correspondent, aiming their silver-and-white reflectors at her impossibly perfect skin and hair as they ran through a lighting check. A man with a Betacam on his shoulder was panning the cramped operating room and talking to New York through a Bluetooth headset clipped to his ear.
It was history in the making.
History in the making. She had heard it repeated over and over, like a mantra. It might even have been true. But at this moment, all she could think of was how to keep from vomiting into the sink.
“Nerves?” asked Florinda, the circulating OR nurse, as she passed with a cart full of instruments.
“Mm-hmm.” Ali faked a smile as she leaned against the rim of the sink. If only nerves were all it was. The sweet lemon scent of the hand soap did nothing to conceal the smells of iodine and alcohol, and the mixture of all three together roiled her stomach. She stepped back from the sink and closed her eyes. Someone was shouting in an unintelligible Eastern European accent—something about power, a power cable, a power box. She heard the five-minute scrub timer ding. And then she heard a voice from on high—the voice of the god of the neurosurgical operating suite, Dr. Richard Helvelius himself.
“Th-that had better be one of your yoga exercises, Dr. O’Day.” He spoke with a slight stutter that was almost Apollonian in him, as though it proved how carefully he weighed and sifted every word. “Tell me you’re p-priming your mind for its encounter with destiny.”
“You know what it is,” said Ali, frowning at his tease.
“You mean you haven’t … I, uh, I thought you had…”
She opened her eyes and looked at him, his head bent slightly toward her from his six-foot-four-inch height. Seen from this angle, his craggy features softened, and that famed aquiline nose of his relinquished its all-powerful pugnacity. It was just his big blue gray eyes she saw—the eyes she had fallen in love with.
“I’ve been a little tied up, setting the stage for your big show,” she said. “Destiny is hard work, Richard. I’ve hardly slept in four days.”
Helvelius laid his strong, warm hand against her spine and gently pushed her back to the scrub sink, back to the iodine and the alcohol and the sickening-sweet lemon scent. He bent even lower to speak confidentially into her ear. “I appreciate that, Ali. In fact, I’m a little w-worried for you.”
“Don’t be,” she said. “I’ve scheduled a quiet little D and C tomorrow, after all the hullabaloo dies down. Ute Heckart from Perinatal’s doing it. She’ll be very discreet.”
“And you’re still sure that’s what you w-w-want?”
“Don’t talk about what I want.” Ali involuntarily touched the back of her hand to her mouth, undoing her five-minute scrub. “It’s for the best,” she mumbled.
“It doesn’t have to b-b-be like that. This b-baby could be good for us.”
Ali clamped her eyes as a new wave of nausea hit her. “Please don’t call it a baby,” she said through clenched teeth.
Helvelius opened his mouth to speak, but was cut off. Kathleen Brown’s skin tones and hair were perfect at last, and the crew director had just gotten the thirty-second signal from New York. Helvelius was hastened into the operating room by one of the Huns, a young man in thick glasses and an oversized yellow surgical gown.
“You, too, Ali,” said Helvelius, looking back at her. “We’ll scrub in later.”
Ali followed him, stooping through the tangle of cables and plastic tubing, holding her dripping wet hands in front of her chest. Helvelius was led to a place on one side of the narrow surgical bed, opposite Kathleen Brown. On the bed sat a boy of seven, who seemed dwarfed by all the cameras and monitors. He had a round, beautiful face, with healthy pink cheeks and a snub nose that wiggled as he chewed pensively on his lower lip. The back of his head had been shaved, leaving a halo of curly white blond hair. His forehead and scalp were dotted with little squares of white tape, from which dangled green, red, and yellow wires.
The excited grin on the little boy’s face coaxed a smile from Ali. As she passed, she bent to one side and whispered a greeting to the young patient, who laughed in return. But there was no time to talk. Someone reached under her elbow and ushered her to a position behind Helvelius, close to a high blue-cloth-draped table covered with stainless steel instruments, outside the line of view of the camera.
Although a small TV monitor beside her seemed to show a nearly empty operating theater, that was a trick of the camera angle. The room was actually so packed with crew and gear that Ali could barely see the operating table. She strained to get a better view. She had come in at 6:00 A.M. to police the setup of the film equipment, laying down red tape on the floor to mark off sterile and nonsterile areas. Now she had no way of telling whether her lines were being respected. Still holding her hands in front of her, Ali tightened her fingers into fists as the crew lurched into action around her. Lights blinked, hand signals waved, and on every side technicians darted back and forth or crouched on taut haunches. It was like standing in the middle of a beehive—an anarchy of buzzing and bustling. There was nothing she could do about it. She had been reduced to a bystander in her own operating room.
Ali squinted under the sunlike glare of the reflectors. Across the table, Dr. Helvelius and Kathleen Brown could not help blinking. But the young patient at the epicenter of all this hurly-burly did not blink at all.
The voice with the Eastern European accent was heard again, counting backward, “Fifteen, fourteen, thirteen, twelve…”
On the TV monitor, Ali watched the live broadcast of America Today from New York. The network anchor Amy Richmond was talking from her desk. Behind her was a still shot of the three gleaming steel-and-glass high-rise towers that were the core of Fletcher Memorial Medical Center, which she could hear being described as “the sprawling flagship hospital of one of the oldest medical schools in the country.”
“We have an unprecedented entrée today into the leading edge of medical research, where Dr. Richard Helvelius and his team in Chicago are about to perform a groundbreaking operation. If all goes according to plan, it could be a day to rival the first operation under ether in 1846 or the first heart transplant in 1967. After today, ethicists and philosophers will be on the airwaves, arguing about how the very concept of mortality will have to be redefined.…”
Ali scowled. Yes, yes, history in the making. Glory, priority, celebrity—that’s what mattered to these Huns, with their cameras and microphones and perfect hair. They worshipped fame, and they expected to share in it, because they were the first to spread it over the airwaves. But what if all didn’t go according to plan? What would their story be then? Would that still make history?
Amy Richmond went on talking. “Our network news team will be covering every phase of this momentous undertaking, beginning with our live segment on America Today, and continuing with a full hour update on our Emmy-winning newsmagazine Lifeline, at nine o’clock Eastern tonight. For more, let’s go to Kathleen Brown, who is in the operating room right now.”
At a cue from the crew director, a small light on the Betacam went red, and Kathleen Brown began to speak.
“Hello, Amy. You’re right. History is about to be made today here at Fletcher Memorial. With me is Dr. Richard Helvelius, the chairman of the Department of Neurosurgery, a pioneer in the treatment of patients with brain tumors and spinal cord injuries. Dr. Helvelius?”
On the monitor, Ali saw Helvelius smile. “Good morning, Kathleen. Hello, Amy,” he said. “This is an exciting day for all of us.”
Ali noticed that Helvelius was speaking in his lecturing voice, pitched a little higher than his usual gravelly baritone. It had always amazed Ali that the stutter that Helvelius had in normal conversation disappeared completely when he spoke in public.
“And who is that with you?” asked Amy Richmond.
“This bright young man is Jamie Winslow, a patient of mine. America is looking on, Jamie. Do you know what a TV camera is?”
“It’s a machine that can see for people that can’t be here. TV is just like radio, except they have SpongeBob and Yu-Gi-Oh!”
“There’s a TV camera pointing at you right now. Is there anything you’d like to say to anyone out there?”
“Just hi! To Mrs. Gore and Mr. Tabor and Mrs. Rutledge at the Grossman School, and to my friends, Judd, Rog, and Felipe. This place is awesome, guys. What they do in this operating room rocks.”
“Thank you, Jamie.”
“Oh, can I say one more thing?”
“This is for the Cubs—hang in there. Miracles do happen. If I can do it, you can, too.”
Helvelius shook his head with the gravity of a doctor at the bedside of a hopeless case. “I’m sorry, Jamie. The Cubs may be beyond the help of medical science this season.”
Jamie laughed, and his laughter ran like a ripple through the room, clearing the air of tension. The nurses and camera crew laughed with him. Even Dr. Helvelius laughed. But Ali didn’t so much as crack a smile. Jamie’s very life was at stake, and there was so much that could go wrong. She knew that the distraction of a single second could spell the difference between triumph and catastrophe.
Resuming his professorial tone, Helvelius turned back toward the camera. “Jamie is blind, and has been since he was three years old, when he developed a benign growth in the brain called an AVM, or arteriovenous malformation. It’s basically a knot of expanded blood vessels that looks and feels just like a handful of worms. In Jamie’s case, it’s grown to about the size of a lemon, and it’s sitting in the occipital lobe, the hindmost part of the brain, which is the primary center for vision. We’ve already taken out part of the AVM in two earlier operations. Today, we’ll take out the rest, and then … and then we’re going to put something new in its place.”
“Just what is that, Dr. Helvelius?” asked Kathleen Brown.
“We call it the SIPNI device. That’s short for Self-Integrating Prosthetic Neural Implant. You see, the AVM long ago destroyed Jamie’s visual brain center. Even with the AVM removed, he will still be blind. What the SIPNI device does is substitute for the missing part of his brain.”
“How is that possible?”
“Well, SIPNI is a kind of minibrain in itself. It’s a very special type of self-contained computer.”
Helvelius pointed to the device, wrapped in a blue envelope with a clear plastic window and sealed with what looked like striped masking tape. The camera showed little but the glare of the plastic, but Ali knew well what was inside. It was the size and shape of a robin’s egg. Its surface was darkly metallic, reflecting light from thousands of honeycomb facets, like a diamond wrought by a fairy gem cutter. It had cost much more than any mere diamond, too—millions in government and industry grants, years of toil, brains and bodies worn out from nonstop work—and, not least of all, relationships strained to the breaking point.
But Helvelius did not speak of the cost. “Don’t let its small size fool you,” he said. “It uses a parallel array of miniaturized nanochips, with as much sheer calculating power as a conventional minicomputer. It can perform all the image-processing functions that Jamie needs to be able to see. But the really astounding feature is the software that operates it. That’s something we’ve developed here at Fletcher Memorial. It represents a major breakthrough in artificial intelligence.”
The camera switched from a close-up of the bag containing the SIPNI device to Helvelius’s face. Ali felt a twinge of jealousy as she saw how aroused Helvelius was by the camera. His eyes positively sparkled. His straight, wide, thin-lipped mouth moved vigorously, baring his lower teeth with every “e” and “w” he spoke. A shock of gray hair, still bearing traces of black, wagged over his high forehead. Even his face’s anchor, his grand patrician nose, came alive, nostrils flaring.
Yesterday, no one but Ali could have moved him so deeply. Today, the Jezebel’s eye of history had stolen his heart.
Helvelius led with his chin as he spoke. “You see, SIPNI can learn, adapt, and model itself, based on the input it receives from Jamie’s brain. That’s exactly what it needs to do, if it’s going to reach out and reconnect with all those millions of brain cells that once converged on the visual center. Not just the fibers from his optic nerves, but also those involved in remembering images, or coordinating hand and eye movements, or joining mental pictures to emotion or to the senses of hearing and smell. We can’t begin to untangle the complexity of all that signaling and countersignaling. But SIPNI can do it.”
“You mean it can think?”
“In a way, yes. For that, you might ask Kevin—Kevin O’Day, that is—our resident artificial intelligence expert. Kevin, does SIPNI think?”
“Aye, verily, milord,” came a voice from across the room.
Ali shuddered. Like a blue note in a Mozart sonata, the sarcasm in Kevin’s answer jarred everyone in the room. Kathleen Brown’s mouth hung open unflatteringly. Dr. Helvelius tore off his glasses, as though he were going to throw them. “Look, K-Kevin—” he began, but words failed him.
The camera cut abruptly to a thirtysomething young man in dark-rimmed spectacles who sat at a computer console across the room. Ali’s heart sank as she saw the patronizing smirk on his face. She recognized that look. She had been married to Kevin O’Day for five years. She knew that look meant trouble.
Like everyone else, Kevin O’Day was dressed in regulation blue scrubs. But instead of the standard blue shower cap, he had covered his hair with a yellow and green silk Japanese head scarf. Although his fine and regular features appeared ordinary from a distance, close-up he was strikingly handsome, even beautiful, with penetrating blue eyes that contrasted with his red goatee and the slight orange freckling of his skin. His bare forearms could have modeled a lecture in topographic anatomy, with their sharply incised muscles and tendons almost popping through the skin. They were, as Ali well knew, the forearms of an accomplished rock-climber who could effortlessly haul himself up by line and piton.
Kevin kicked his chair away from the console, as though he were swinging around to face Kathleen Brown, but he never really looked at her. His eyes stayed focused on the computer monitor, as though this were the only thing worth his glance. “Everyone’s all gaga that a machine can think. Why is that so hard to accept? The human brain itself is a machine—nothing more than a computer hardwired with blinking neurons instead of vacuum tubes or silicon. What’s so special about a neuron? At over a thousand cubic microns, it’s bulky as hell, and it requires an enormous expenditure of energy just to stay alive and hold a place in the big net. SIPNI beats that hands down. Not only does it think, but it thinks faster and more elegantly than the brain tissue it replaces.”
Kevin was veering off-script. Ali could only guess at what he was up to, for she had deliberately avoided meeting his gaze when she entered the room. Looking at him these days was like looking at a car wreck. She couldn’t afford to get caught up in the feelings she still had for him—not today, when so much depended upon her protecting her clarity of mind.
On TV, Kevin could be seen tapping his hand against his monitor, as though reaching out to it for support. “When this kid sees again, he’s going to have smarter eyes than he ever did before. Seeing isn’t just like projecting a movie on a big screen, it’s the way the brain finds patterns, edges, similarities, axes of motion—stuff like that. It took a hundred million years or so for evolution to program us to turn flashes of light into real seeing. This kid is about to leapfrog another hundred million years beyond either you or me. Beyond hawk and eagle. Beyond Michelangelo.”
“That’s incredible!” said Kathleen Brown.
“Incredible is just a word for not believing. If you don’t find me authoritative enough, ask Odin.”
“Who is Odin?”
“SIPNI’s father. Odin is the program I interface with on this terminal. But program is a measly word for what he is. It’s like me calling you a souped-up amoeba that smokes and drinks too much coffee. Odin is the most advanced computational system on this planet. He won last year’s Loebner Prize.”
Kathleen Brown scowled at the small palmtop that stored her background notes, as though reproaching it for having left her blindsided by this important fact. “The Loebner Prize? What’s that?”
“It’s a hundred thousand dollars to the first artificial intelligence system that can’t be distinguished from a real person chatting on the telephone. Of course, when I say Odin won, I’m referring to the bronze medal, not the hundred grand. Nobody’s been able to walk away with the gold as yet. But Odin does keep getting better.”
It was classic Kevin, Ali noted. In almost the same breath, he had bragged about himself and insulted Kathleen Brown in front of an audience of millions. And somehow managed to get away with it.
Kathleen Brown seemed not to notice. “And Odin helped to design SIPNI?” she asked with her trademark perky tone.
“Both hardware and software. Some of this stuff is just way too complex for my puny brain to figure out. So we work together, like Rodgers and Hammerstein. And yes, for your information, he thinks.”
“Does he talk?”
“Sure.” Kevin flicked a switch on a small module beside the computer. “This activates his external speakers. Odin, this lady would like to have a word with you.”
There was a pop as the speaker came on, and then there sounded a mellow, silvery, masculine voice—a voice as familiar to Ali as that of any human being in the room. “I KNOW. I’VE BEEN LISTENING.”
Kathleen Brown smiled uneasily. “Listening? How?”
“I’VE BEEN WATCHING AMERICA TODAY, OF COURSE.”
“YOU NEEDN’T BE. I WATCH ALL SEVENTY-FOUR CHANNELS OF THE HOSPITAL CABLE NETWORK.”
“All seventy-four at once?”
“YES. I’M VERY WELL INFORMED ABOUT THE OUTSIDE WORLD. WOULD YOU CARE TO DISCUSS THE CURRENT CRISIS IN LIBYA?”
“Thanks, but I’m more interested in you.”
“THAT’S ONLY NATURAL.”
Ali smiled at the perplexed look on Kathleen Brown’s face. Odin, of course, wasn’t being smug with her. He was incapable of human vanity. He was, in fact, the only presence in Operating Room Three who was unsullied by self-interest. He was the perfect incarnation of the classic Stoic ideal of ataraxia—absolute freedom from human emotions, and from all the exasperating conflicts that came tangled up with them. There had been days—many days, especially lately—when Ali had envied him that freedom.
Kathleen Brown looked as if she were struggling for a comeback. “How powerful a computer are you?” she finally said, a bit lamely.
“I’M NOT A COMPUTER AT ALL. NO MORE THAN YOU, KATHLEEN BROWN, ARE THE THREE POUNDS OR SO OF GRAY AND WHITE TISSUE YOU CALL A BRAIN. WE BOTH MAKE USE OF A PHYSICAL SUBSTRATUM TO CARRY OUT OUR MENTAL PROCESSES. BUT THERE IS MUCH MORE TO US THAN THE PHYSICAL SUBSTRATUM, ISN’T THERE? WE ARE OUR THOUGHTS, IN THE FINAL ANALYSIS.”
“So are you Mac or PC?”
Ali was irritated by Kathleen Brown’s naïveté and ignorance, her cute posturing. She wasn’t taking Odin seriously. She had no idea of his complexity, or of the years of obsessive work that Kevin had spent perfecting him.
Odin, too, noticed her ignorance, but without irritation. He answered her as an all-wise, all-patient father might answer the little girl on his knee.
“YOU DON’T UNDERSTAND MY POINT, KATHLEEN BROWN. I AM A PROCESS, AND NOT A MACHINE. PROCESS IS ANOTHER WAY OF DESCRIBING WHAT YOU HUMANS THINK OF AS SPIRIT. I EXIST IN AND BEYOND THE ENTIRE NETWORK OF MEDICAL CENTER COMPUTERS. THAT INCLUDES THE LARGE RESEARCH MAINFRAMES, AS WELL AS THE ONE THOUSAND TWO HUNDRED AND FORTY-SEVEN DESKTOP COMPUTERS DISTRIBUTED IN EVERY WARD AND OFFICE OF THIS HOSPITAL. I SENSE WHEREVER UNUSED COMPUTING POWER OR DATA STORAGE SPACE IS AVAILABLE, AND I CONSTANTLY SHIFT MY ACTIVITIES TO TAKE ADVANTAGE OF IT.”
“Don’t people have to use those computers?”
“I MODIFY MY ACTIVITIES ACCORDINGLY. IT GIVES RISE TO A KIND OF SLEEP-WAKE CYCLE, MUCH AS YOU HUMANS HAVE. THE SLOWEST PART OF MY CYCLE IS FROM THREE O’CLOCK TO FOUR O’CLOCK EACH AFTERNOON, WHEN THE HOSPITAL INTERNS ARE TYPING UP THE DISCHARGE ORDERS FOR THEIR PATIENTS. MY MOST ACTIVE PERIOD IS AT NIGHT.”
Ali remembered those nights—endless bleary-eyed hours she had spent feeding streams of laboratory data to Odin. Many of the experiments needed to create SIPNI were too complex and too expensive to perform outright, so Ali and the rest of the team relied on Odin to create virtual models of the ways molecules, cells, and circuits interacted with one another. While this saved years of trial and error, the immense computations required could only be performed during Odin’s peak operating window at night—and it always seemed there was an early surgery waiting for Ali the next day. Those nights had aged her. She wondered whether her whole life would be enough to make up for the sleep she had sacrificed on the altar of science during those grueling months.
On-screen, Kathleen Brown cocked her head and lifted her chin, in a gesture that looked like an obvious attempt to convey a perky thoughtfulness. “You’ve been described as the father of SIPNI. Do you feel any paternal pride today?”
“I DON’T HAVE FEELINGS, KATHLEEN BROWN.”
“But you can think?”
“CERTAINLY. I CAN THINK AND I CAN ACT. BUT MY THINKING IS BASED UPON LOGIC, FREED FROM ALL EMOTIONAL ENTANGLEMENTS. WHEN DECISIONS ARE REQUIRED, I CONDUCT A MULTI-TIERED ANALYSIS OF RISKS AND BENEFITS. I KNOW NOTHING OF FEAR, DOUBT, ANGER, REMORSE, OR SELFISHNESS—OTHER THAN THEIR DEFINITIONS, AND THEIR EFFECTS UPON HUMAN BEINGS.”
“I HAVE AN INTIMATE WORKING RELATIONSHIP WITH MY CREATOR, DR. KEVIN O’DAY. I EXIST WHOLLY TO SATISFY HIM. I CAN ANTICIPATE HIS NEEDS WITHOUT REQUIRING AN EXPLICIT DIRECTIVE. THESE ARE COUNTERPARTS OF THE HUMAN ATTRIBUTES OF DEVOTION, LOYALTY, AND SOLICITUDE. SO IN AN OPERATIONAL SENSE I CAN BE SAID TO BE CAPABLE OF LOVE, OR AT LEAST OF TRAITS BY WHICH LOVE MAY ARGUABLY BE DEFINED. BUT I AM DEVOID OF POSSESSIVENESS, JEALOUSY, OR THE EXPECTATION OF REQUITAL OF MY FRIENDSHIP.”
“Amazing!” said Kathleen Brown, swaying her hips and rising on her toes like a bashful prom queen. “Are you available in a home computer version?”
Helvelius cleared his throat. “Apparently Odin is not above a little grandstanding. Kevin, could you switch the speaker off?”
Kevin hesitated for a stubborn half second, and then flicked the speaker switch. “Sorry, Odin,” he said, letting his hand catch in the air, like a backhanded salute.
Ali was relieved that Kevin was off the air. He had been flippant, even rude, but she knew that he was capable of much worse.
* * *
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:
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:
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.
Now he had nothing but guilt to show for it. Even though he had arranged for daytime home care, he had underestimated how difficult it would be for his mother to feed herself or even to drink. Several days ago, she had had a bad choking episode that led to pneumonia. Would that have happened in the nursing home? Harry felt responsible. Sure, he pulled strings to make sure she got a private room and the best doctors in the city, but that didn’t erase the fact that for the sake of pride and honor he had played roulette with his mother’s life.
“Can you hold for a minute, Mr. Lewton? I think I see Dr. Weiss coming down the hall.”
Harry glanced at the TV. Christ, look at those peepers! The shy, sphinxlike woman on the monitor kept looking off into space as she spoke. But now and then, quite abruptly, she would turn and stare straight into the camera, opening her green eyes wide under the canopy of her dark, gull-wing eyebrows. When she did that, she seemed to reach out from the TV screen and look directly at Harry himself.
Harry was intrigued by her, by her bashfulness, which struck him as a paradox that needed explanation. She paws the ground like a scared kitten. But she’s a panther, no kitten. If she wanted to, she could eat you for breakfast. You or any man. Just look at those eyes.
From time to time, Harry glanced at the other monitors—closed surveillance circuits that gave him a godlike view of what was going on anywhere in the hospital. The pièce de résistance was a sixty-inch LCD screen on the wall to his left, which displayed a schematic of glowing lights showing the status of every door, elevator, and fire alarm within the 1.2 million square feet of the medical center. The lights were all green now, not a yellow or red among them. The medical center was functioning as it ought to, like a healthy, vigorous body.
The only irritant to the healthy body was on the plaza outside the main entrance. The cameras showed a couple dozen protesters circling there, as they chanted and waved signs, all neatly printed in the same blue paint: STOP DR. FRANKENSTEIN;, NO AMALGAMATION OF MAN AND MACHINE; HONOR THE HUMAN SOUL; WHERE WILL IT END?; FLETCHER MEMORIAL PLAYS GOD.
TV cameras always brought out groups like this. But this bunch wasn’t doing any harm. They were staying out of the flowerbeds and they weren’t blocking the traffic circle. Not like those Green fanatics who tried to shut down the oil terminals back when he was an assistant security director in Texas City. That had been his first job after leaving police work, and he had handled it well. He had gone strictly by the book, which was easy enough when you’ve just finished your MBA in security management. No one got hurt, nothing got blown up, and—bottom line—the tankers came in on time. If only everything else in his life had turned out as smoothly as that. It almost made up for that fiasco at Nacogdoches.
Back on the center screen, Dr. Ali O’Day was trying to explain what a neural net was, and, judging by the puzzled look on Kathleen Brown’s face, it was an uphill climb. Ali looked different than she had the few times Harry had seen her in person, in the hallways or in the staff dining room. It’s that surgical cap she’s wearing, he decided. It swept her wavy, shoulder-length sable hair out of sight, and starkly accentuated the forehead and cheekbones of her shield-shaped face. Yes, that’s it. And now he noticed something he hadn’t seen before—a little bitty hump to the ridge of her nose. Not an Irish nose, he told himself. Not the nose of an O’Day. Her mouth, too, had something exotic about it—a little wide for her jawline, with lips spread apart, as if frozen in the beginning of a smile.
What was that about her husband? Harry had never noticed a ring on Ali’s finger, and in the three months he had been at Fletcher Memorial, he had never seen this man with her. Kevin, that’s what his name was. Even now, she never glanced at Kevin in that fleeting, automatic way that husbands and wives did when they needed to get a fix on something familiar or bolster themselves with a shot of approval. He was a lucky bastard if a husband is what he really was. But something was missing. Definitely something was missing.
Harry heard a rattle at the other end of the phone line.
“Dr. Weiss here,” said an impatient voice.
“Doctor, this is Harry Lewton. My mother—”
“She’s not doing as well as we’d like. She’s still running a temperature, and the portable X-ray we took during the night shows a worsening of her pneumonia. I’m going to add imipenem, an IV antibiotic. That should give us better coverage for anaerobic bacteria.”
“How serious is this?”
“Aspiration pneumonia is a leading cause of death in patients with Parkinson’s disease.”
What an impersonal prick, thought Harry. “If there’s some kind of test or treatment she needs, make sure you do it,” he said. “I’ll pay whatever insurance doesn’t cover.”
Dr. Weiss ignored Harry’s offer. “We have her on ten liters of oxygen right now. We’re watching closely for any signs of respiratory fatigue.”
The internist’s voice was suddenly drowned out by the opening banjo lick of “Foggy Mountain Breakdown,” Harry’s cell phone’s ringtone. In one movement, Harry snatched the phone from his belt and shook it open. There was an incoming text page. Harry had been expecting a message from the VP for finance, but this was something very different. When he held the screen up to the light, he saw, in plain block letters:
FMMC CRITICAL STATUS. VERIFY THREAT PARCEL ENDO LOBBY. AWAIT INSTRUCTIONS 0830. MAINTAIN STRICT SILENCE. DO NOT EVACUATE. ALL OPERATIONS MUST REMAIN NORMAL. PENALTY FOR DISREGARD CATASTROPHIC. GOD IS GREAT.
“Aw, Christ!” he muttered. “You gotta be shittin’ me!”
“Excuse me?” said Dr. Weiss.
“Sorry, I didn’t mean you. It’s a … it’s a text page. Look, I’ve got something I have to deal with right now. Can we talk later, after I’ve had a chance to see my mother for myself?”
“Yes. Let’s do that.”
Harry read over the message several times, making sure that he hadn’t gotten it wrong. Was it a joke? A bona fide threat? The hospital got prank calls all the time, but he had yet to get one on his personal pager. He scrolled up and down, but there was no callback number. By reflex, he turned to his computer and accessed Logline, the com tracker that could be used to trace calls going to any phone or pager within the hospital. The page had come from within the hospital.
Briskly punching the number, he heard one ring and then the sound of a woman’s voice. “Neurosurgery.”
“This is Harry Lewton, in security. Did you just text-page me?”
“No, Mr. Lewton.”
“Whose line is this?”
“This is the office of Dr. Richard Helvelius.”
“Well, somebody just paged me from this telephone.”
“I didn’t page you.”
The snippiness in her voice irked him. “And you are?”
“Aileen. Aileen Zimmerman, Dr. Helvelius’s administrative assistant.”
“Who else is there?”
“No one. Not at 7:30 A.M. I’m just opening up the office. Dr. Helvelius is in surgery.”
“I know that, goddamn it. The whole country knows it. It’s a national event.”
There was a long pause on the other end of the line. At last the woman’s voice came through, tautly. “How can I help you, Mr. Lewton?”
“Could anyone else have been using this phone within the last five minutes?”
“No. As I said—”
“Well, if you think of someone who may have, call me back.”
Harry slammed down the phone. Jesus! It would be a hell of a trick for Dr. Helvelius to page him while prepping for surgery on live TV. Logline must have gotten the number wrong. Make a note of that for the system support people. A fourteen-million-dollar upgrade, and still more bugs than a bayou in July.
Endo Lobby. That could be either the Endocrinology Clinic or the Endoscopy Clinic. If the call had really come from someone in the hospital, you’d think they would have known that and been more specific. So it could still be an outsider, a hoax. Maybe one of these protesters. A disgruntled patient. A kid with nothing but time on his hands. God! Why not a little respect for people who have to work for a living?
Still, there was something about the message that made him uneasy. Something a little too businesslike for your typical wiseass kid. Harry took a swig of his coffee and got up from his desk. Hurrying toward the door, he threw on a blue blazer that hid the slim 9mm Beretta holstered under his armpit. Endocrinology was closest, just down the Pike. Start there.
Copyright © 2013 by Scott Britz-Cunningham
Excerpted from Code White by Scott Britz-Cunningham Copyright © 2013 by Scott Britz-Cunningham. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author
SCOTT BRITZ-CUNNINGHAM was born and raised in the Chicago area. An MD and a PhD, he works as a staff radiologist at the Brigham and Women's Hospital in Boston, and is an assistant professor of radiology at Harvard Medical School. Dr. Britz-Cunningham lives in Quincy, Massachusetts, with his artist wife, Evelyn, and his son, Alexander. He is the author of Code White.
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