All Cry Chaos (25 page)

    The embroidery on the man's jacket read M
axwell Beck, Director
of Clinical Cardiology
. Poincaré had been rushed to the emergency room of one of Boston's teaching hospitals; later, as he drifted in a medicated sleep, he was transferred to the Cardiac Care Unit, where he now lay tethered to his bed like a dog to a fence post. Aside from the births of his son and grandchildren, he had not a single positive memory of hospitals. He fought a strong impulse to pull out the tubing and run.

    "If I'm in a normal rhythm," he said, "I can leave."

    Beck worked a stethoscope across his chest, then felt the pulses at his wrists and ankles. "Your normal rhythm was the good news, Inspector. Do you realize how dehydrated you were? That sent your atrial fibrillation into overdrive. You may be on the mend, but the truth is you should do nothing more than sleep and eat for a month. I mean it. You are perilously close to a total collapse."

    The advancing hands on the wall clock would not permit a collapse. "I'll compromise," Poincaré offered.

    "You're hardly in a position—"

    "Discharge me this afternoon—by 4 o'clock. I have a flight to Québec City at 9, and I have to get back to my hotel first and collect my things." He shifted his weight, which pulled at the tube beneath the sheets. "I feel fine," he said.

    "Compared to what? Death?"

    "Remove the tubes. That would be a start."

    Poincaré looked beyond the partially drawn curtain in an effort to be anywhere else and saw an orderly wheeling a fully dressed man down the corridor. The woman following the gurney might as well have been trailing a hearse.

    "Before I can release you," said Beck, "I need the results of a cardiac enzyme test. Assuming that's fine, 4 o'clock it is. My job is to get you back in sinus rhythm. Beyond that, you're free to dig your own grave. People do. We can fix your atrial fibrillation," continued the doctor. "What are your triggers? It's caffeine for some people. It could be a cold drink on a hot day or a large meal late at night. Sometimes, heavy drinking. Do you have any obvious triggers? You'll want to avoid them."

    "I couldn't really pin it down,' said Poincaré, who was thinking that his whole life must be a trigger—and that someone had already dug his grave. "The attacks come of their own accord," he said. "They leave just as suddenly. I try to ignore them."

    "Which is difficult, I imagine."

    Poincaré nodded.

    "What about your latest onset—tell me what was happening."

    The question recalled his visit to Charles Bell and a large problem, potentially. Poincaré scanned the room, then asked the doctor to open the closet door. He saw only his suit and shoes. "Is there a briefcase beneath my bed?"

    Beck looked. "I don't see one."

    "Does your emergency room log personal effects when someone's admitted?"

    "Your valuables are in the hospital safe. I wouldn't worry." The doctor glanced at Poincaré's chart. "I see the ER called your headquarters in Lyon. It was the only contact number they could find in your wallet, and when someone arrives presenting with cardiac symptoms they look for next of kin. The note here says they left a message on a machine."

    Poincaré tried lifting himself off the bed. With Monforte in midexit, he would have to leave the hospital before the new director could locate and then recall him from the field for health reasons. Beck, meanwhile, was leaning against the window sill and watching his patient closely. "Take your new medication on schedule and promise to stay hydrated. Eight glasses a day."

    "Including wine?"

    "No. But if you're drinking wine, make it red. Do you sleep well?"

"Not particularly."

    Poincaré looked at the wall clock. "Could you arrange for me to use a computer? I need to meet someone online at 3 o'clock."

    Beck folded his arms. "Did you hear the part about total collapse?"

    It was not a fair fight. Poincaré had tubes running into and out of him. He wore a thin hospital gown over a body that smelled of stale sweat. He made a calculation. "Let me explain," he said. "The person I'm after cut the breathing tube of a six-year-old, killing her. This same person very likely assassinated or assisted in the assassination of a once-in-a generation talent, using a modified explosive that any of a dozen terrorist organizations would be eager to use. I've got to be on a computer at 3 o'clock and I've got to leave here by 4 o'clock. I appreciate that I'm not the one to be making demands, Dr. Beck. But I need to leave here."

    "What happens when you crumble?" said the doctor.

    A fair question. Poincaré assumed that nothing would happen. Interpol would drop the case and the Americans, attending to more pressing needs, would forget about Fenster. Etienne had disowned him; Claire might never wake up. All he could do was face his jailer and lie: "If I go down, someone takes my place."

    Beck approached the bed. "I won't call your superiors and insist they recall you because I don't know what it means to hunt a killer, let alone a child killer. But you had better rest. Once you're strong again, we can repair your heart." He took a pad of paper and sketched a diagram of the heart's chambers, then drew lines—catheters, he called them—that could be threaded through the femoral artery north to the heart where, guided by imaging technology, surgeons could shoot radio-frequency pulses to destroy the cells that triggered his arrhythmia. "Lately," said Beck, "the technique is becoming more science than art. You ought to consider it."

    "You could restore a normal rhythm?"

    "If we agree on how to define normal, yes." Beck flipped through Poincaré's file for a pamphlet that the nursing staff left with each patient admitted for atrial fibrillation. "Usually you'd get this on discharge, but since you asked—" He turned to a page with several graphs.

    "You're probably thinking when you say
normal
that a healthy human heart beats like a metronome. Not so. These graphs show you electrocardiograms of a healthy heart over three minutes, thirty minutes, and three hundred minutes. Notice that the rates go up and down: they're somewhat erratic but erratic within known, healthy parameters. At any interval we choose to measure, the normal heart might beat two beats at a rate of seventy per minute—if it was sustained over a full minute, then for the next four beats run at ninety, then eighty then up to eighty-five. A normal rhythm has a variability that we can't predict because in every dynamic system—and the beating human heart is a dynamic system—the details of the motion are buried in such complexity that they are, even in principle, unknowable."

    "Because?"

    "Because the possibility of disorder is always present in an orderly system."

    Poincaré recognized something in these graphs. "They have the same shape over different scales," he said.

    "That's right. To look at one you might as well be looking at the others. The part contains the whole."

    
Fractal
. Poincaré turned the word over in his mind. He felt himself slipping down a chute. He said the word.

    "Right again, Inspector. Cardiologists have begun talking to mathematicians, believe it or not. I've always thought these tracings look like the day's stock market returns. Or the Alps. Here's a compressed, fifteen-minute strip of your heartbeat when you were admitted with A-Fib," said Beck, pulling a page from Poincaré's chart. "Look how the beats range from fifty to one hundred twenty, then drop down again—dominated by chaos.

"There's no discernable pattern here, the hallmark of A-Fib. Now let's print a compressed strip of your last fifteen minutes in sinus rhythm." He tapped several keys on a console and presented the printout.

"Look how your normal rate's variable but orderly—not a metronome, but orderly within a bounded range and rate. What's particularly telling are the intervals between beats, which in normal sinus rhythm are also orderly. In A-Fib, chaos rules the intervals. You'll get a slow beat, wait three seconds for four rapid beats, wait another two for a run of slow beats and then speed up to 120. And so on. In the EP lab we measure intervals with a mathematical tool called a Poincaré Plot." Beck looked up. "Any relation? It's not a common name."

    "My great-grandfather," said Poincaré, "pulling strings from beyond the grave."

    "A coincidence!"

    Poincaré hoped so, because otherwise this case was finding him.

    "Look, Inspector. It comes down to this: we have a ninety percent chance of permanently restoring your sinus rhythm by destroying the cells responsible for flipping your otherwise healthy heart into the exaggerated chaos of A-Fib. No errant cells, no cascade into chaos. You'd be a good candidate for the surgery."

    Beck checked the time. "My advice is to catch this person you're after, rest a few months, and do the surgery. There's a good group in Bordeaux if you want to pursue this in France. Or come see us here in Boston. In the meantime, you should get some relief with the new medication." Beck inspected the IV bags and flicked at a line. "I'll write the discharge papers for 4 PM. And I mean what I said about hydration. It will get back to me if you die from exhaustion, and that would be inconvenient for both of us."

The nurse who had removed his IV lines and urine bag sent for his belongings while he showered, and Poincaré emerged from the tiny bathroom to unpleasant news: the plastic bag on his bed held a wallet, watch, wedding band, satellite phone, and hotel key—but no briefcase. The ER nurse who admitted him the previous day did not recall seeing it, nor did the orderly who wheeled him to the cardiac unit. All Poincaré could do was to leave one message for Charles Bell and another for the dispatcher at the ambulance company. At 3 PM, dressed and ready to leave, he logged onto the Math League Website. Hubert Levenger had instructed him to keep Chambi online, chatting, for the fifteen minutes his tracing software needed to establish her location.

>Hey there, Tutor.

>Antoine, is that you? How are the word problems going?

>Got a new one today: A commuter train leaves the station at 7 AM, traveling at a speed of 80 mph. An express train leaves the station at 8 AM traveling at 100 mph. At what distance and at what time will the express train meet the commuter train?

>A classic. What's your approach so far? >I've worked it out by drawing two lines with 1 hour blocks, but this is an algebra class.

>That's right. Use x's and y's. Use your head, not your fingers. How many equations do you need?

>One, I think. You still sleepy? >Silly question! It's only dinnertime."

    Poincaré's watch read 3:12 PM. She was still east of him. He checked a second window open on the computer. Dinner at 9 PM could place her as far east as Sofia or Jerusalem. But he doubted that. She was seated before a computer somewhere between 10° West and 15° East longitude. That left a large slice of the globe to search, but it was not the entire globe. He checked his watch and began working through the problem with her, feigning confusion at every turn to stall for time. After ten minutes, he produced the solution: