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 right 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.