The Surgeon (25 page)

get a medal?" She rose to her feet and shoved her chair, hard,
against the desk. "Administrative duty. Marquette's turned me
into a fucking desk jockey. Thanks a lot."
In silence he watched her walk away and could think of
nothing to say, nothing he could do to repair the rift between
them.
He went to his own workstation and sank into the chair. I'm
a dinosaur, he thought, lumbering through a world where truth-
tellers are despised. He could not think about Rizzoli now. The
case against Pacheco had disintegrated, and they were back
at square one, hunting for a nameless killer.
Three raped women. It kept coming back to that. How was
the Surgeon finding them? Only Nina Peyton had reported her
rape to the police. Elena Ortiz and Diana Sterling had not.
Theirs was a private trauma, known only to the rapists, their
victims, and the medical professionals who had treated them.
But the three women had sought medical attention in different
places: Sterling in the office of a Back Bay gynecologist. Ortiz
in the Pilgrim Hospital E.R. Nina Peyton in the Forest Hills
Women's Clinic. There was no overlap of personnel, no
doctor or nurse or receptionist who had come into contact with
more than one of these women.
Somehow the Surgeon knew those women were damaged,
and he was attracted by their pain. Sexual killers choose their
prey from among the most vulnerable members of society.
They seek women they can control, women they can degrade,

women who do not threaten them. And who is more fragile
than a woman who has been violated?
As Moore walked out, he paused to look at the wall where
the photos of Sterling, Ortiz, and Peyton were tacked. Three
women, three rapes.
And a fourth. Catherine was raped in Savannah.
He blinked as the image of her face suddenly flashed into
mind, an image that he could not help adding to that victims'
gallery on the wall.
Somehow it all goes back to what happened that night in
,
Savannah. It all goes back to Andrew Capra.

sixteen
I   n the heart of Mexico City, human blood once ran
in rivers. Beneath the foundations of the modern metropolis
lie the ruins of Templo Mayor, the great Aztec site which
dominated ancient Tenochtitl�n. Here, tens of thousands of
unfortunate victims were sacrificed to the gods.
The day I walked those temple grounds, I felt some
measure of amusement that nearby loomed a cathedral,
where Catholics light candles and whisper prayers to a
merciful God in heaven. They kneel near the very place

merciful God in heaven. They kneel near the very place
where the stones were once slippery with blood. I visited on a
Sunday, not knowing that on Sundays admission is free to
the public, and the Museum of Templo Mayor was aswarm
with children, their voices echoing brightly in the halls. I do
not care for children, or for the disorder they stir; if ever I
return, I will remember to avoid museums on Sundays.
But it was my last day in the city, so I put up with the
irritating shards of noise. I wanted to see the excavation, and
I wanted to tour Hall Two. The Hall of Ritual and Sacrifice.
The Aztecs believed that death is necessary for life. To
maintain the sacred energy of the world, to ward off
catastrophe and ensure that the sun continues to rise, the
gods must be fed human hearts. I stood in the Hall of Ritual
and saw in the glass case, the sacrificial knife which had
,
carved flesh. It had a name: Tecpatl Ixcuahua. The Knife with
the Broad Forehead. The blade was made of flint, and the
handle was in the shape of a kneeling man.
How I wondered, does one go about cutting out a human
,
heart when equipped with only a flint knife?
That question consumed me as I walked later that
afternoon in the Alameda Central, ignoring the filthy urchins
who trailed behind me, begging for coins. After a while they
realized I could not be seduced by brown eyes or toothy
smiles, and they left me alone. At last I was allowed some

measure of peace--if such a thing is possible in the
cacophony of Mexico City. I found a cafe, and sat at an
outdoor table sipping strong coffee, the only patron who
chose to be outside in the heat. I crave the heat; it soothes
my cracking skin. I seek it the way a reptile seeks a warm
rock. And so, on that sweltering day, I drank coffee and
considered the human chest, puzzling over how best to
approach the beating treasure within.
The Aztec sacrificial ritual has been described as swift,
with a minimum of torture, and this presents a dilemma. I
know it is hard work to crack through the sternum and
separate the breastbone, which protects the heart like a
shield. Cardiac surgeons make a vertical incision down the
center of the chest, and split the sternum in two with a saw .
They have assistants who help them separate the bony
halves, and they use a variety of sophisticated instruments
to widen the field, every tool fashioned of gleaming stainless
steel.
An Aztec priest, with only a flint knife, would have
problems using such an approach. He would need to pound
on the breastbone with a chisel to split it down the center,
and there would be a great deal of struggling. A great deal of
screaming.
No, the heart must be taken through a different approach.

A horizontal cut running between two ribs, along the side?
This, too, has its problems. The human skeleton is a sturdy
structure, and to spread two ribs apart, wide enough to insert
a hand, requires strength and specialized tools. Would an
approach from below make more sense? One swift slice
down the belly would open the abdomen, and all the priest
would have to do is slice through the diaphragm and reach
up to grasp the heart. Ah, but this is a messy option, with
intestines spilling out upon the altar. Nowhere in the Aztec
carvings are sacrificial victims depicted with loops of bowel
protruding.
Books are wonderful things; they can tell you anything,
everything, even how to cut out a heart using a flint knife,
with a minimum of fuss. I found my answer in a textbook with
the title Human Sacrifice and Warfare, written by an
academic (my, universities are interesting places these
days!), a man named Sherwood Clarke, whom I would very
much like to meet someday.
I think we could teach each other many things.
The Aztecs, Mr. Clarke says, used a transverse
thoracotomy to cut out the heart. The wound slices across
the front of the chest, starting between the second and third
rib, on one side of the sternum, cutting across the
breastbone to the opposite side. The bone is broken
transversely, probably with a sharp blow and a chisel. The

result is a gaping hole. The lungs, exposed to outside air,
instantly collapse. The victim quickly loses consciousness.
And while the heart continues to beat, the priest reaches into
the chest and severs the arteries and veins. He grasps the
organ, still pulsating, from its bloody cradle and lifts it to the
sky.
And so it was described in Bernardino de Sahagan's
Codex Florentio, The General History of New Spain:
An offering priest carried the eagle cane,
Set it standing on the captive's breast, there where the
heart had been, stained it with blood, indeed submerged it
in the blood.
Then he also raised the blood in dedication to the sun.
It was said: `Thus he giveth the sun to drink.'
And the captor thereupon took the blood of his captive
In a green bowl with a feathered rim.
The sacrificing priests poured it in for him there.
In it went the hollow cane, also feathered,

And then the captor departed to nourish the demons.
Nourishment for the demons.
How powerful is the meaning of blood.
I think this as I watch a thread of it being sucked into a
needle-thin pipette. All around me are racks of test tubes,
and the air hums with the sound of machines. The ancients
considered blood a sacred substance, sustainer of life, food
for monsters, and I share their fascination with it, even
though I understand it is merely a biological fluid, a
suspension of cells in plasma. The stuff with which I work
every day.
The average seventy-kilogram human body possesses
only five liters of blood. Of that, 45 percent is cells and the
rest is plasma, a chemical soup made up of 95 percent
water, the rest proteins and electrolytes and nutrients. Some
would say that reducing it to its biological building blocks
peels away its divine nature, but I do not agree. It is by
looking at the building blocks themselves that you recognize
its miraculous properties.
The machine beeps, a signal that the analysis is
complete, and a report rolls out of the printer. I tear off the
sheet and study the results.

With just a glance, I know many things about Mrs. Susan
Carmichael, whom I have never met. Her hematocrit is low
--only 28, when it should be 40. She is anemic, lacking a
normal supply of red blood cells, which are the carriers of
oxygen. It is the protein hemoglobin, packed within these
disk-shaped cells, that makes our blood red, that pinkens
the nailbeds and brings a pretty flush to a young girl's
cheeks. Mrs. Carmichael's nailbeds are sallow and if one
,
peeled back her eyelid, the conjunctiva would appear only
the palest shell-pink. Because she is anemic, her heart
must work all the faster to pump diluted blood through her
arteries, and so she pauses at every flight of stairs to catch
her breath, to calm her racing pulse. I picture her stooping
forward, her hand to her throat, her chest heaving like a
bellows. Anyone passing her on the stairs can see she is not
well.
I can see it just by looking at this sheet of paper.
There is more. On the roof of her mouth are flecks of red
--petechiae, where blood has broken through capillaries
and lodged in the mucous membrane. Perhaps she's
unaware of these pinpoint bleeds. Perhaps she has noticed
them elsewhere on her body, beneath her fingernails, or on
her shins. Perhaps she finds bruises she cannot account for,
startling islands of blue on her arms or her thighs, and she
thinks hard about when she might have injured herself. Was

it a bump against the car door? The child clinging to her leg
with sturdy fists? She seeks external reasons, when the real
cause lurks in her bloodstream.
Her platelet count is twenty thousand; it should be ten
times higher. Without platelets, the tiny cells that help form
clots, the slightest bump may leave a bruise.
There is yet more to be learned from this flimsy sheet of
paper.
I look at her white blood cell differential, and I see the
explanation for her woes. The machine has detected the
presence of myeloblasts, primitive white blood cell
precursors that do not belong in the bloodstream. Susan
Carmichael has acute myeloblastic leukemia.
I picture her life as it will play out in the months to come. I
see her lying prone on a treatment table, her eyes closed in
pain as the bone marrow needle penetrates her hip.
I see her hair falling out in clumps, until she surrenders to
the inevitable, and the electric shaver.
I see mornings with her crouched over the toilet bowl, and
long days of staring at the ceiling, her universe shrunken to
the four walls of her bedroom.
Blood is the giver of life, the magic fluid that sustains us.

But Susan Carmichael's blood has turned against her; it
flows in her veins like poison.
All these intimate details I know about her, without ever
having met her.
I transmit the STAT results by fax to her physician, place
the lab report in the out basket for later delivery, and reach
for the next specimen. Another patient, another tube of
blood.
The connection between blood and life has been known
since the dawn of man. The ancients did not know that blood
is made in the marrow or that most of it is merely water, but
,
they did appreciate its power in ritual and sacrifice. The
Aztecs used bone perforators and agave needles to pierce
their own skin and draw blood. They poked holes through
their lips or tongue or the flesh of their chest, and the blood
that resulted was their personal offering to the gods. Today
such self-mutilation would be called sick and grotesque, the
hallmark of insanity.
I wonder what the Aztecs would think of us.
Here I sit, in my sterile surroundings, garbed in white, my
hands gloved to protect them from an accidental splash.
How far we have strayed from our essential natures. Just the
sight of blood can make some men faint, and people scurry

to hide such horrors from the public eye, hosing down
sidewalks where blood has spilled, or covering children's
eyes when violence erupts on the television. Humans have
lost touch with who, and what, they really are.
Some of us, however, have not.
We walk among the rest, normal in every respect;
perhaps we are more normal than anyone else because we
have not allowed ourselves to be wrapped and mummified in
civilization's sterile bandages. We see blood, and we do not
turn away. We recognize its lustrous beauty; we feel its
primitive pull.
Everyone who drives past an accident and cannot help
but look for the blood understands this. Beneath the
revulsion, the urge to turn away, throbs a greater force.
Attraction.
We all want to look. But not all of us will admit it.
It is lonely, walking among the anesthetized. In the
afternoon, I wander the city and breathe in air so thick I can
almost see it. It warms my lungs like heated syrup. I search
the faces of people on the street, and I wonder which among
them is my dearest blood brother, as once you were. Is there
anyone else who has not lost touch with the ancient force
that flows through us all? I wonder if we would recognize

each other if we met, and I fear we would not, because we
have hidden ourselves so deeply beneath the cloak that
passes for normality.
So I walk alone. And I think of you, the only one who ever
understood.

seventeen
A  s a physician, Catherine had looked at death so
many times that its visage was familiar to her. She had stared
into a patient's face and watched life drain from the eyes,
turning them blank and glassy. She had seen skin fade to
gray, the soul in retreat, seeping away like blood. The practice
of medicine is as much about death as it is about life, and
Catherine had long ago made Death's acquaintance over the
cooling remains of a patient. She was not afraid of corpses.
Yet as Moore turned onto Albany Street and she saw the