Death was always the end. How could death not be the end?
A needle stung Lindsey’s left arm.
“This time,” the angel said softly, “there’s still a chance. We’ve got a special program here, a real—”
Another woman burst into the room and interrupted excitedly: “Nyebern’s in the hospital!”
A communal sigh of relief, almost a quiet cheer, swept those gathered in the room.
“He was at dinner in Marina Del Rey when they reached him. He must’ve driven like a bat out of Hell to get back here this fast.”
“You see, dear?” the angel said to Lindsey. “There’s a chance. There’s still a chance. We’ll be praying.”
So what? Lindsey thought bitterly. Praying never works for me. Expect no miracles. The dead stay dead, and the living only wait to join them.
THREE
1
Guided by procedures outlined by Dr. Jonas Nyebern and kept on file in the Resuscitation Medicine Project office, the Orange County General Hospital emergency staff had prepared an operating room to receive the body of Hatchford Benjamin Harrison. They had gone into action the moment the on-site paramedics in the San Bernardino Mountains had reported, by police-band radio, that the victim had drowned in near-freezing water but had suffered only minor injuries in the accident itself, which made him a perfect subject for Nyebern. By the time the air ambulance was touching down in the hospital parking lot, the usual array of operating-room instruments and devices had been augmented with a bypass machine and other equipment required by the resuscitation team.
Treatment would not take place in the regular emergency room. Those facilities offered insufficient space to deal with Harrison in addition to the usual influx of patients. Though Jonas Nyebern was a cardiovascular surgeon and the project team was rich with surgical skills, resuscitation procedures seldom involved surgery. Only the discovery of a severe internal injury would require them to cut Harrison, and their use of an operating room was more a matter of convenience than necessity.
When Jonas entered from the surgical hallway after preparing himself at the scrub sinks, his project team was waiting for him. Because fate had deprived him of his wife, daughter, and son, leaving him without family, and because an innate shyness had always inhibited him from making friends beyond the boundaries of his profession, these were not merely his colleagues but the only people in the world with whom he felt entirely comfortable and about whom he cared deeply.
Helga Dorner stood by the instrument cabinets to Jonas’s left, in the penumbra of the light that fell from the array of halogen bulbs over the operating table. She was a superb circulating nurse with a broad face and sturdy body reminiscent of any of countless steroid-saturated female Soviet track stars, but her eyes and hands were those of the gentlest Raphaelite Madonna. Patients initially feared her, soon respected her, eventually adored her.
With solemnity that was characteristic in moments like this, Helga did not smile but gave Jonas a thumbs-up sign.
Near the bypass machine stood Gina Delilo, a thirty-year-old RN and surgical technician who chose, for whatever reasons, to conceal her extraordinary competence and sense of responsibility behind a pert, cute, ponytailed exterior that made her seem to be an escapee from one of those old Gidget or beach-party movies that had been popular decades ago. Like the others, Gina was dressed in hospital greens and a string-tied cotton cap that concealed her blond hair, but bright-pink ankle socks sprouted above the elastic-edged cloth boots that covered her shoes.
Flanking the operating table were Dr. Ken Nakamura and Dr. Kari Dovell, two hospital-staff physicians with successful local private practices. Ken was a rare double threat, holding advanced degrees in internal medicine and neurology. Daily experience with the fragility of human physiology drove some doctors to drink and caused others to harden their hearts until they were emotionally isolated from their patients; Ken’s healthier defense was a sense of humor that was sometimes twisted but always psychologically healing. Kari, a first-rate specialist in pediatric medicine, was four inches taller than Ken’s five-feet-seven, reed-thin where he was slightly pudgy, but she was as quick to laugh as the internist. Sometimes, though, a profound sadness in her eyes troubled Jonas and led him to believe that a cyst of loneliness lay so deep within her that friendship could never provide a scalpel long or sharp enough to excise it.
Jonas looked at each of his four colleagues in turn, but none of them spoke. The windowless room was eerily quiet.
For the most part the team had a curiously passive air, as if disinterested in what was about to happen. But their eyes gave them away, for they were the eyes of astronauts who were standing in the exit bay of an orbiting shuttle on the brink of a space walk: aglow with excitement, wonder, a sense of adventure—and a little fear.
Other hospitals had emergency-room staffs skilled enough at resuscitation medicine to give a patient a fighting chance at recovery, but Orange County General was one of only three centers in all of southern California that could boast a separately funded, cutting-edge project aimed at maximizing the success of reanimation procedures. Harrison was the project’s forty-fifth patient in the fourteen months since it had been established, but the manner of his death made him the most interesting. Drowning. Followed by rapidly induced hypothermia. Drowning meant relatively little physical damage, and the chill factor dramatically slowed the rate at which postmortem cell deterioration took place.
More often than not, Jonas and his team had treated victims of catastrophic stroke, cardiac arrest, asphyxiation due to tracheal obstruction, or drug overdose. Those patients usually had suffered at least some irreversible brain damage prior to or at the moment of death, before coming under the care of the Resuscitation Project, compromising their chances of being brought back in perfect condition. And of those who had died from violent trauma of one kind or another, some had been too severely injured to be saved even after being resuscitated. Others had been resuscitated and stabilized, only to succumb to secondary infections that swiftly developed into toxic shock. Three had been dead so long that, once resuscitated, brain damage was either too severe to allow them to regain consciousness or, if they were conscious, too extensive to allow them to lead anything like a normal life.
With sudden anguish and a twinge of guilt, Jonas thought of his failures, of life incompletely restored, of patients in whose eyes he had seen the tortured awareness of their own pathetic condition....
“This time will be different.” Kari Dovell’s voice was soft, only a whisper, but it shattered Jonas’s reverie.
Jonas nodded. He felt considerable affection for these people. For their sake more than his own, he wanted the team to have a major, unqualified success.
“Let’s do it,” he said.
Even as he spoke, the double doors to the operating room crashed open, and two surgical orderlies rushed in with the dead man on a gurney. Swiftly and skillfully, they transferred the body onto the slightly tilted operating table, treating it with more care and respect than they might have shown a corpse in other circumstances, and then exited.
The team went to work even as the orderlies were heading out of the room. With speed and economy of movement, they scissored the remaining clothes off the dead man, leaving him naked on his back, and attached to him the leads of an electrocardiograph, an electroencephalograph, and a skin-patch digital-readout thermometer.
Seconds were golden. Minutes were beyond price. The longer the man remained dead, the less chance they had of bringing him back with any degree of success whatsoever.
Kari Dovell adjusted the controls of the EKG, sharpening the contrast. For the benefit of the tape recording that was being made of the entire procedure, she repeated what all of them could see: “Flat line. No heartbeat.”
“No alpha, no beta,” Ken Nakamura added, confirming the absence of all electrical activity in the patient’s brain.
Having wrapped the pressure cuff of a sphygmomanometer around the patient’s righ
t arm, Helga reported the reading they expected: “No measurable blood pressure.”
Gina stood beside Jonas, monitoring the digital-readout thermometer. “Body temperature’s forty-six degrees.”
“So low!” Kari said, her green eyes widening with surprise as she stared down at the cadaver. “And he must’ve warmed up at least ten degrees since they pulled him out of that stream. We keep it cool in here, but not that cool.”
The thermostat was set at sixty-four degrees to balance the comfort of the resuscitation team against the need to prevent the victim from warming too fast.
Looking up from the dead man to Jonas, Kari said, “Cold is good, okay, we want him cold, but not too damned cold. What if his tissues froze and he sustained massive cerebral-cell damage?”
Examining the dead man’s toes and then his fingers, Jonas was almost embarrassed to hear himself say, “There’s no indication of vesicles—”
“That doesn’t prove anything,” Kari said.
Jonas knew that what she said was true. They all knew it. There would not have been time for vesicles to form in the dead flesh of frost-bitten fingertips and toes before the man, himself, had died. But, damn it, Jonas did not want to give up before they had even started.
He said, “Still, there’s no sign of necrotic tissue—”
“Because the entire patient is necrotic,” Kari said, unwilling to let go of it. Sometimes she seemed as ungainly as a spindly-legged bird that, although a master of the air, was out of its element on the land. But at other times, like now, she used her height to advantage, casting an intimidating shadow, looking down at an adversary with a hard gaze that seemed to say better-listen-to-me-or-I-might-peck-your-eyes-out-mister. Jonas was two inches taller than Kari, so she couldn’t actually look down at him, but few women were that close to being able to give him even a level-eyed stare, and the effect was the same as if he had been five-feet-two.
Jonas looked at Ken, seeking support.
The neurologist was having none of it. “In fact the body temperature could have fallen below freezing after death, then warmed up on the trip here, and there’d be no way for us to tell. You know that, Jonas. The only thing we can say for sure about this guy is that he’s deader than Elvis has ever been.”
“If he’s only forty-six degrees now ..., ” Kari said.
Every cell in the human body is composed primarily of water. The percentage of water differs from blood cells to bone cells, from skin cells to liver cells, but there is always more water than anything else. And when water freezes, it expands. Put a bottle of soda in the freezer to quick-chill it, leave it too long, and you’re left with just the exploded contents bristling with shattered glass. Frozen water bursts the walls of brain cells—all body cells—in a similar fashion.
No one on the team wanted to revive Harrison from death if they were assured of bringing back something dramatically less than a whole person. No good physician, regardless of his passion to heal, wanted to battle and defeat death only to wind up with a conscious patient suffering from massive brain damage or one who could be sustained “alive” only in a deep coma with the aid of machines.
Jonas knew that his own greatest weakness as a physician was the extremity of his hatred for death. It was an anger he carried at all times. At moments like this the anger could swell into a quiet fury that affected his judgment. Every patient’s death was a personal affront to him. He tended to err on the side of optimism, proceeding with a resuscitation that could have more tragic consequences if it succeeded than if it failed.
The other four members of the team understood his weakness, too. They watched him expectantly.
If the operating room had been tomb-still before, it was now as silent as the vacuum of any lonely place between the stars where God, if He existed, passed judgment on His helpless creations.
Jonas was acutely aware of the precious seconds ticking past.
The patient had been in the operating room less than two minutes. But two minutes could make all the difference.
On the table, Harrison was as dead as any man had ever been. His skin was an unhealthy shade of gray, lips and fingernails and toenails a cyanotic blue, lips slightly parted in an eternal exhalation. His flesh was utterly devoid of the tension of life.
However, aside from the two-inch-long shallow gash on the right side of his forehead, an abrasion on his left jaw, and abrasions on the palms of his hands, he was apparently uninjured. He had been in excellent physical condition for a man of thirty-eight, carrying no more than five extra pounds, with straight bones and well-defined musculature. No matter what might have happened to his brain cells, he looked like a perfect candidate for resuscitation.
A decade ago, a physician in Jonas’s position would have been guided by the Five-Minute Limit, which then had been acknowledged as the maximum length of time the human brain could go without blood-borne oxygen and suffer no diminution of mental faculties. During the past decade, however, as resuscitation medicine had become an exciting new field, the Five-Minute Limit had been exceeded so often that it was eventually disregarded. With new drugs that acted as free-radical scavengers, machines that could cool and heat blood, massive doses of epinephrine, and other tools, doctors could step well past the Five-Minute Limit and snatch some patients back from deeper regions of death. And hypothermia—extreme cooling of the brain which blocked the swift and ruinous chemical changes in cells following death—could extend the length of time a patient might lie dead yet be successfully revived. Twenty minutes was common. Thirty was not hopeless. Cases of triumphant resuscitation at forty and fifty minutes were on record. In 1988, a two-year-old girl in Utah, plucked from an icy river, was brought back to life without any apparent brain damage after being dead at least sixty-six minutes, and only last year a twenty-year-old woman in Pennsylvania had been revived with all faculties intact seventy minutes after death.
The other four members of the team were still staring at Jonas.
Death, he told himself, is just another pathological state.
Most pathological states could be reversed with treatment.
Dead was one thing. But cold and dead was another.
To Gina, he said, “How long’s he been dead?”
Part of Gina’s job was to serve as liaison, by radio, with the on-site paramedics and make a record of the information most vital to the resuscitation team at this moment of decision. She looked at her watch—a Rolex on an incongruous pink leather band to match her socks—and did not even have to pause to calculate: “Sixty minutes, but they’re only guessing how long he was dead in the water before they found him. Could be longer.”
“Or shorter,” Jonas said.
While Jonas made his decision, Helga rounded the table to Gina’s side and, together, they began to study the flesh on the cadaver’s left arm, searching for the major vein, just in case Jonas decided to resuscitate. Locating blood vessels in the slack flesh of a corpse was not always easy, since applying a rubber tourniquet would not increase systemic pressure. There was no pressure in the system.
“Okay, I’m going to call it,” Jonas said.
He looked around at Ken, Kari, Helga, and Gina, giving them one last chance to challenge him. Then he checked his own Timex wristwatch and said, “It’s nine-twelve P.M., Monday night, March fourth. The patient, Hatchford Benjamin Harrison, is dead... but retrievable.”
To their credit, whatever their doubts might have been, no one on the team hesitated once the call had been made. They had the right—and the duty—to advise Jonas as he was making the decision, but once it was made, they put all of their knowledge, skill, and training to work to insure that the “retrievable” part of his call proved correct.
Dear God, Jonas thought, I hope I’ve done the right thing.
Already Gina had inserted an exsanguination needle into the vein that she and Helga had located. Together they switched on and adjusted the bypass machine, which would draw the blood out of Harrison’s body and gradually warm it t
o one hundred degrees. Once warmed, the blood would be pumped back into the still-blue patient through another tube feeding a needle inserted in a thigh vein.
With the process begun, more urgent work awaited than time to do it. Harrison’s vital signs, currently nonexistent, had to be monitored for the first indications of response to therapy. The treatment already provided by the paramedics needed to be reviewed to determine if a previously administered dose of epinephrine—a heart-stimulating hormone—was so large as to rule out giving more of it to Harrison at this time. Meanwhile Jonas pulled up a wheeled cart of medications, prepared by Helga before the body had arrived, and began to calculate the variety and quantity of ingredients for a chemical cocktail of free-radical scavengers designed to retard tissue damage.
“Sixty-one minutes,” Gina said, updating them on the estimated length of time that the patient had been dead. “Wow! That’s a long time talking to the angels. Getting this one back isn’t going to be a weenie roast, boys and girls.”
“Forty-eight degrees,” Helga reported solemnly, noting the cadaver’s body temperature as it slowly rose toward the temperature of the room around it.
Death is just an ordinary pathological state, Jonas reminded himself. Pathological states can usually be reversed.
With her incongruously slender, long-fingered hands, Helga folded a cotton surgical towel over the patient’s genitals, and Jonas recognized that she was not merely making a concession to modesty but was performing an act of kindness that expressed an important new attitude toward Harrison. A dead man had no interest in modesty. A dead man did not require kindness. Helga’s consideration was a way of saying that she believed this man would once more be one of the living, welcomed back to the brotherhood and sisterhood of humanity, and that he should be treated henceforth with tenderness and compassion and not just as an interesting and challenging prospect for reanimation.
2
The weeds and grass were as high as his knees, lush from an unusually rainy winter. A cool breeze whispered through the meadow. Occasionally bats and night birds passed overhead or swooped low off to one side, briefly drawn to him as if they recognized a fellow predator but immediately repelled when they sensed the terrible dif ference between him and them.
He stood defiantly, gazing up at the stars shining between the steadily thickening clouds that moved eastward across the late-winter sky. He believed that the universe was a kingdom of death, where life was so rare as to be freakish, a place filled with countless barren planets, a testament not to the creative powers of God but to the sterility of His imagination and the triumph of the forces of darkness aligned against Him. Of the two realities that coexisted in this universe—life and death—life was the smaller and less consequential. As a citizen in the land of the living, your existence was limited to years, months, weeks, days, hours. But as a citizen in the kingdom of the dead, you were immortal.
He lived in the borderland.
He hated the world of the living, into which he had been born. He loathed the pretense to meaning and manners and morals and virtue that the living embraced. The hypocrisy of human interaction, wherein selflessness was publicly championed and selfishness privately pursued, both amused and disgusted him. Every act of kindness seemed, to him, to be performed only with an eye to the payback that might one day be extracted from the recipient.
His greatest scorn—and sometimes fury—was reserved for those who spoke of love and made claims to feeling such a thing. Love, he knew, was like all the other high-minded virtues that family, teachers, and priests blathered about. It didn’t exist. It was a sham, a way to control others, a con.
He cherished, instead, the darkness and strange anti-life of the world of the dead in which he belonged but to which he could not yet return. His rightful place was with the damned. He felt at home among those who despised love, who knew that the pursuit of pleasure was the sole purpose of existence. Self was primary. There were no such things as “wrong” and “sin.”
The longer he stared at the stars between the clouds, the brighter they appeared, until each pinpoint of light in the void seemed to prick his eyes. Tears of discomfort blurred his vision, and he lowered his gaze to the earth at his feet. Even at night, the land of the living was too bright for the likes of him. He didn’t need light to see. His vision had adapted to the perfect blackness of death, to the catacombs of Hell. Light was not merely superfluous to eyes like his; it was a nuisance and, at times, an abomination.
Ignoring the heavens, he walked out of the field, returning to the cracked pavement. His footsteps echoed hollowly through this place that had once been filled with the voices and laughter of multitudes. If he had wanted, he could have moved with the silence of a stalking cat.
The clouds parted and the lunar lamp beamed down, making him wince. On all sides, the decaying structures of his hideaway cast stark and jagged shadows in moonlight that would have seemed wan to anyone else but that, to him, shimmered on the pavement as if it were luminous paint.
He took a pair of sunglasses from an inside pocket of his leather jacket and put them on. That was better.
For a moment he hesitated, not sure what he wanted to do with the rest of the night. He had two basic choices, really: spend the remaining pre-dawn hours with the living or with the dead. This time it was even an easier choice than usual, for in his current mood, he much preferred the dead.
He stepped out of a moon-shadow that resembled a giant, canted, broken wheel, and he headed toward the moldering structure where he kept the dead. His collection.
3
“Sixty-four minutes,” Gina said, consulting her Rolex with the pink leather band. “This one could get messy.”
Jonas couldn’t believe how fast time was passing, just speeding by, surely faster than usual, as if there had been some freak acceleration of the continuum. But it was always the same in situations like this, when the difference between life and death was measured in minutes and seconds.
He glanced at the blood, more blue than red, moving through the clear-plastic exsanguination tube into the purring bypass machine. The average human body contained five liters of blood. Before the resuscitation team was done with Harrison, his five liters would have been repeatedly recycled, heated, and filtered.
Ken Nakamura was at a light board, studying head and chest X rays and body-sonograms that had been taken in the air ambulance during its hundred-eighty-mile-per-hour journey from the base of the San Bernardinos to the hospital in Newport Beach. Kari was bent close to the patient’s face, examining his eyes through an ophthalmoscope, checking for indications of dangerous cranial pressure from a buildup of fluid on the brain.