Under The Knife

A fan-favorite novel by internationally bestselling author Tess Gerritsen

For attorney David Ransom, it begins as an open-and-shut case: malpractice. Then Dr. Kate Chesne storms into his office, daring him to seek out the truth—that she’s being framed. When another patient turns up dead, David starts to believe her. Somewhere in the Honolulu hospital, a killer walks freely. And now David finds himself asking the same questions Kate is desperate to have answered.

Who is next—and why?

VANISH

“Gerritsen’s latest novel is a tense, taut thriller that grabs readers from the get-go and never lets up.”

—Booklist

BODY DOUBLE

“An electric series of startling twists, the revelation of ghoulishly practical motives and a nail-biting finale make this Gerritsen’s best to date.”

—Publishers Weekly

“The story zips along…. A delightfully bizarro plot twist.”

—Entertainment Weekly

THE APPRENTICE

”Well-drawn characters and a compelling story will grab readers’ interest and earn Gerritsen more admirers.”

—Booklist

“Leave the lights on, check the closets, and lock the doors before cracking [The Apprentice].”

—People

THE SURGEON

“Gliding as smoothly as a scalpel in a confident surgeon’s hand, this tale proves that Gerritsen…has morphed into a…suspense novelist whose growing popularity is keeping pace with her ever-finer writing skills.”

—Publishers Weekly

“Gerritsen fans know by now what to expect from her: a fascinating story with a gripping plot and believably human characters. Such is The Surgeon, and, in places, then some. Let new readers learn what the fans delight in.”

—Booklist

THE SINNER

“Gerritsen gives atmospheric depth to her tale… satisfyingly gritty.”

—Publishers Weekly

Under the Knife

Tess Gerritsen

www.mirabooks.co.uk

To my mother and father

CONTENTS

Cover

Back Cover Text

Praise

Title Page

Dedication

PROLOGUE

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

CHAPTER ELEVEN

CHAPTER TWELVE

CHAPTER THIRTEEN

CHAPTER FOURTEEN

CHAPTER FIFTEEN

CHAPTER SIXTEEN

EPILOGUE

Extract

Endpage

Copyright

PROLOGUE

DEAR GOD, HOW the past comes back to haunt us.

From his office window, Dr. Henry Tanaka stared out at the rain battering the parking lot and wondered why, after all these years, the death of one poor soul had come back to destroy him.

Outside, a nurse, her uniform spotty with rain, dashed to her car. Another one caught without an umbrella, he thought. That morning, like most Honolulu mornings, had dawned bright and sunny. But at three o’clock the clouds had slithered over the Koolau range and now, as the last clinic employees headed for home, the rain became a torrent, flooding the streets with a river of dirty water.

Tanaka turned and stared down at the letter on his desk. It had been mailed a week ago; but like so much of his correspondence, it had been lost in the piles of obstetrical journals and supply catalogs that always littered his office. When his receptionist had finally called it to his attention this morning, he’d been alarmed by the name on the return address: Joseph Kahanu, Attorney at Law.

He had opened it immediately.

Now he sank into his chair and read the letter once again.

Dear Dr. Tanaka,

As the attorney representing Mr. Charles Decker, I hereby request any and all medical records pertaining to the obstetrical care of Ms. Jennifer Brook, who was your patient at the time of her death….

Jennifer Brook. A name he’d hoped to forget.

A profound weariness came over him—the exhaustion of a man who has discovered he cannot outrun his own shadow. He tried to muster the energy to go home, to slog outside and climb into his car, but he could only sit and stare at the four walls of his office. His sanctuary. His gaze traveled past the framed diplomas, the medical certificates, the photographs. Everywhere there were snapshots of wrinkled newborns, of beaming mothers and fathers. How many babies had he brought into the world? He’d lost count years ago….

It was a sound in the outer office that finally drew him out of his chair: the click of a door shutting. He rose and went to peer out at the reception area. “Peggy? Are you still here?”

The waiting room was deserted. Slowly his gaze moved past the flowered couch and chairs, past the magazines neatly stacked on the coffee table, and finally settled on the outer door. It was unlocked.

Through the silence, he heard the muted clang of metal. It came from one of the exam rooms.

“Peggy?” Tanaka moved down the hall and glanced into the first room. Flicking on the light, he saw the hard gleam of the stainless-steel sink, the gynecologic table, the supply cabinet. He turned off the light and went to the next room. Again, everything was as it should be: the instruments lined up neatly on the counter, the sink wiped dry, the table stirrups folded up for the night.

Crossing the hall, he moved toward the third and last exam room. But just as he reached for the light switch, some instinct made him freeze: a sudden awareness of a presence—something malevolent—waiting for him in the darkness.

In terror, he backed out of the room. Only as he spun around to flee did he realize that the intruder was standing behind him.

A blade slashed across his neck.

Tanaka staggered backward into the exam room and toppled an instrument stand. Stumbling to the floor, he found the linoleum was already slick with his blood. Even as he felt his life drain away, a coldly rational pocket of his brain forced him to assess his own wound, to analyze his own chances. Severed artery. Exsanguination within minutes. Have to stop the bleeding…. Numbness was already creeping up his legs.

So little time. On his hands and knees, he crawled toward the cabinet where the gauze was stored. To his half-senseless mind, the feeble light reflecting off those glass doors became his guiding beacon, his only hope of survival.

A shadow blotted out the glow from the hall. He knew the intruder was standing in the doorway, watching him. Still he kept moving.

In his last seconds of consciousness, Tanaka managed to drag himself to his feet and wrench open the cabinet door. Sterile packets rained down from the shelf. Blindly he ripped one apart, withdrew a wad of gauze and clamped it against his neck.

He didn’t see the attacker’s blade trace its final arc.

As it plunged deep into his back, Tanaka tried to scream but the only sound that issued from his throat was a sigh. It was the last breath he took before he slid quietly to the floor.

* * *

CHARLIE DECKER LAY naked in his small hard bed and he was afraid.

Through the window he saw the blood-red glow of a neon sign: The Victory Hotel. Except the t was missing from Hotel. And what was left made him think of Hole, which is what the place really was: The Victory Hole, where every triumph, every joy, sank into some dark pit of no return.

He shut his eyes but the neon seemed to burrow its way through his lids. He turned away from the window and pulled the pillow over his head. The smell of the filthy linen was suffocating. Tossing the pillow aside, he rose and paced over to the window. There he stared down at the street. On the sidewalk below, a stringy-haired blonde in a miniskirt was dickering with a man in a Chevy. Somewhere in the night people laughed and a jukebox was playing “It Don’t Matter Anymore.” A stench rose from the alley, a peculiar mingling of rotting trash and frangipani: the smell of the back streets of paradise. It made him nauseated. But it was too hot to close the window, too hot to sleep, too hot even to breathe.

He went over to the card table and switched on the lamp. The same newspaper headline stared up at him.

Honolulu Physician Found Slain.

He felt the sweat trickle down his chest. He threw the newspaper on the floor. Then he sat down and let his head fall into his hands.

The music from the distant jukebox faded; the next song started, a thrusting of guitars and drums. A singer growled out: “I want it bad, oh yeah, baby, so bad, so bad….”

Slowly he raised his head and his gaze settled on the photograph of Jenny. She was smiling; as always, she was smiling. He touched the picture, trying to remember how her face had felt; but the years had dimmed his memory.

At last he opened his notebook. He turned to a blank page. He began to write.

This is what they told me:

“It takes time…

Time to heal, time to forget.”

This is what I told them:

That healing lies not in forgetfulness

But in remembrance

Of you.

The smell of the sea on your skin;

The small and perfect footprints you leave in the sand.

In remembrance there are no endings.

And so you lie there, now and always, by the sea.

You open your eyes. You touch me.

The sun is in your fingertips.

And I am healed.

I am healed.

CHAPTER ONE

WITH A STEADY HAND, Dr. Kate Chesne injected two hundred milligrams of sodium Pentothal into her patient’s intravenous line. As the column of pale yellow liquid drifted lazily through the plastic tubing, Kate murmured, “You should start to feel sleepy soon, Ellen. Close your eyes. Let go….”

“I don’t feel anything yet.”

“It will take a minute or so.” Kate squeezed Ellen’s shoulder in a silent gesture of reassurance. The small things were what made a patient feel safe. A touch. A quiet voice. “Let yourself float,” Kate whispered. “Think of the sky…clouds….”

Ellen gave her a calm and drowsy smile. Beneath the harsh operating-room lights, every freckle, every flaw stood out cruelly on her face. No one, not even Ellen O’Brien, was beautiful on the operating table. “Funny,” she murmured. “I’m not afraid. Not in the least….”

“You don’t have to be. I’ll take care of everything.”

“I know. I know you will.” Ellen reached out for Kate’s hand. It was only a touch, a brief mingling of fingers. The warmth of Ellen’s skin against hers was one more reminder that not just a body, but a woman, a friend, was lying on this table.

The door swung open and the surgeon walked in. Dr. Guy Santini was as big as a bear and he looked faintly ridiculous in his flowered paper cap. “How we doing in here, Kate?”

“Pentothal’s going in now.”

Guy moved to the table and squeezed the patient’s hand. “Still with us, Ellen?”

She smiled. “For better or worse. But on the whole, I’d rather be in Philadelphia.”

Guy laughed. “You’ll get there. But minus your gallbladder.”

“I don’t know…. I was getting kinda…fond of the thing….” Ellen’s eyelids sagged. “Remember, Guy,” she whispered. “You promised. No scar….”

“Did I?”

“Yes…you did…..”

Guy winked at Kate. “Didn’t I tell you? Nurses make the worst patients. Demanding broads!”

“Watch it, Doc!” one of the O.R. nurses snapped. “One of these days we’ll get you up on that table.”

“Now that’s a terrifying thought,” remarked Guy.

Kate watched as her patient’s jaw at last fell slack. She called softly: “Ellen?” She brushed her finger across Ellen’s eyelashes. There was no response. Kate nodded at Guy. “She’s under.”

“Ah, Katie, my darlin’,” he said, “you do such good work for a—”

“For a girl. Yeah, yeah. I know.”

“Well, let’s get this show on the road,” he said, heading out to scrub. “All her labs look okay?”

“Blood work’s perfect.”

“EKG?”

“I ran it last night. Normal.”

Guy gave her an admiring salute from the doorway. “With you around, Kate, a man doesn’t even have to think. Oh, and ladies?” He called to the two O.R. nurses who were laying out the instruments. “A word of warning. Our intern’s a lefty.”

The scrub nurse glanced up with sudden interest. “Is he cute?”

Guy winked. “A real dreamboat, Cindy. I’ll tell him you asked.” Laughing, he vanished out the door.

Cindy sighed. “How does his wife stand him, anyway?”

For the next ten minutes, everything proceeded like clockwork. Kate went about her tasks with her usual efficiency. She inserted the endotracheal tube and connected the respirator. She adjusted the flow of oxygen and added the proper proportions of forane and nitrous oxide. She was Ellen’s lifeline. Each step, though automatic, required double-checking, even triple-checking. When the patient was someone she knew and liked, being sure of all her moves took on even more urgency. An anesthesiologist’s job is often called ninety-nine percent boredom and one percent sheer terror; it was that one percent that Kate was always anticipating, always guarding against. When complications arose, they could happen in the blink of an eye.

But today she fully expected everything to go smoothly. Ellen O’Brien was only forty-one. Except for a gallstone, she was in perfect health.

Guy returned to the O.R., his freshly scrubbed arms dripping wet. He was followed by the “dreamboat” lefty intern, who appeared to be a staggering five-feet-six in his elevator shoes. They proceeded on to the ritual donning of sterile gowns and gloves, a ceremony punctuated by the brisk snap of latex.

As the team took its place around the operating table, Kate’s gaze traveled the circle of masked faces. Except for the intern, they were all comfortably familiar. There was the circulating nurse, Ann Richter, with her ash blond hair tucked neatly beneath a blue surgical cap. She was a coolheaded professional who never mixed business with pleasure. Crack a joke in the O.R. and she was likely to flash you a look of disapproval.

Next there was Guy, homely and affable, his brown eyes distorted by thick bottle-lens glasses. It was hard to believe anyone so clumsy could be a surgeon. But put a scalpel in his hand and he could work miracles.

Opposite Guy stood the intern with the woeful misfortune of having been born left-handed.

And last there was Cindy, the scrub nurse, a dark-eyed nymph with an easy laugh. Today she was sporting a brilliant new eye shadow called Oriental Malachite, which gave her a look reminiscent of a tropical fish.

“Nice eye shadow, Cindy,” noted Guy as he held his hand out for a scalpel.

“Why thank you, Dr. Santini,” she replied, slapping the instrument into his palm.

“I like it a lot better than that other one, Spanish Slime.”

“Spanish Moss.”

“This one’s really, really striking, don’t you think?” he asked the intern who, wisely, said nothing. “Yeah,” Guy continued. “Reminds me of my favorite color. I think it’s called Comet cleanser.”

The intern giggled. Cindy flashed him a dirty look. So much for the dreamboat’s chances.

Guy made the first incision. As a line of scarlet oozed to the surface of the abdominal wall, the intern automatically dabbed away the blood with a sponge. Their hands worked automatically and in concert, like pianists playing a duet.

From her position at the patient’s head, Kate followed their progress, her ear tuned the whole time to Ellen’s heart rhythm. Everything was going well, with no crises on the horizon. This was when she enjoyed her work most—when she knew she had everything under control. In the midst of all this stainless steel, she felt right at home. For her, the whooshes of the ventilator and the beeps of the cardiac monitor were soothing background music to the performance now unfolding on the table.

Guy made a deeper incision, exposing the glistening layer of fat. “Muscles seem a little tight, Kate,” he observed. “We’re going to have trouble retracting.”

“I’ll see what I can do.” Turning to her medication cart, she reached for the tiny drawer labeled Succinylcholine. Given intravenously, the drug would relax the muscles, allowing Guy easier access to the abdominal cavity. Glancing in the drawer, she frowned. “Ann? I’m down to one vial of succinylcholine. Hunt me down some more, will you?”

“That’s funny,” said Cindy. “I’m sure I stocked that cart yesterday afternoon.”

“Well, there’s only one vial left.” Kate drew up 5 cc’s of the crystal-clear solution and injected it into Ellen’s IV line. It would take a minute to work. She sat back and waited.

Guy’s scalpel cleared the fat layer and he began to expose the abdominal muscle sheath. “Still pretty tight, Kate,” he remarked.

She glanced up at the wall clock. “It’s been three minutes. You should notice some effect by now.”

“Not a thing.”

“Okay. I’ll push a little more.” Kate drew up another 3 cc’s and injected it into the IV line. “I’ll need another vial soon, Ann,” she warned. “This one’s just about—”

A buzzer went off on the cardiac monitor. Kate glanced up sharply. What she saw on the screen made her jump to her feet in horror.

Ellen O’Brien’s heart had stopped.

In the next instant the room was in a frenzy. Orders were shouted out, instrument trays shoved aside. The intern clambered onto a footstool and thrust his weight again and again on Ellen’s chest.

This was the proverbial one percent, the moment of terror every anesthesiologist dreads.

It was also the worst moment in Kate Chesne’s life.

As panic swirled around her, she fought to stay in control. She injected vial after vial of adrenaline, first into the IV lines and then directly into Ellen’s heart. I’m losing her, she thought. Dear God, I’m losing her. Then she saw one brief fluttering across the oscilloscope. It was the only hint that some trace of life lingered.

“Let’s cardiovert!” she called out. She glanced at Ann, who was standing by the defibrillator. “Two hundred watt seconds!”

Ann didn’t move. She remained frozen, her face as white as alabaster.

“Ann?” Kate yelled. “Two hundred watt seconds!”

It was Cindy who darted around to the machine and hit the charge button. The needle shot up to two hundred. Guy grabbed the defibrillator paddles, slapped them on Ellen’s chest and released the electrical charge.

Ellen’s body jerked like a puppet whose strings have all been tugged at once.

The fluttering slowed to a ripple. It was the pattern of a dying heart.

Kate tried another drug, then still another in a desperate attempt to flog some life back into the heart. Nothing worked. Through a film of tears, she watched the tracing fade to a line meandering aimlessly across the oscilloscope.

“That’s it,” Guy said softly. He gave the signal to stop cardiac massage. The intern, his face dripping with sweat, backed away from the table.

“No,” Kate insisted, planting her hands on Ellen’s chest. “It’s not over.” She began to pump—fiercely, desperately. “It’s not over.” She threw herself against Ellen, pitting her weight against the stubborn shield of rib and muscles. The heart had to be massaged, the brain nourished. She had to keep Ellen alive. Again and again she pumped, until her arms were weak and trembling. Live, Ellen, she commanded silently. You have to live….

“Kate.” Guy touched her arm.

“We’re not giving up. Not yet….”

“Kate.” Gently, Guy tugged her away from the table. “It’s over,” he whispered.

Someone turned off the sound on the heart monitor. The whine of the alarm gave way to an eerie silence. Slowly, Kate turned and saw that everyone was watching her. She looked up at the oscilloscope.

The line was flat.

* * *

KATE FLINCHED AS an orderly zipped the shroud over Ellen O’Brien’s body. There was a cruel finality to that sound; it struck her as obscene, this convenient packaging of what had once been a living, breathing woman. As the body was wheeled off to the morgue, Kate turned away. Long after the squeak of the gurney wheels had faded down the hall, she was still standing there, alone in the O.R.

Fighting tears, she gazed around at the bloodied gauze and empty vials littering the floor. It was the same sad debris that lingered after every hospital death. Soon it would be swept up and incinerated and there’d be no clue to the tragedy that had just been played out. Nothing except a body in the morgue.

And questions. Oh, yes, there’d be questions. From Ellen’s parents. From the hospital. Questions Kate didn’t know how to answer.

Wearily she tugged off her surgical cap and felt a vague sense of relief as her brown hair tumbled free to her shoulders. She needed time alone—to think, to understand. She turned to leave.

Guy was standing in the doorway. The instant she saw his face, Kate knew something was wrong.

Silently he handed her Ellen O’Brien’s chart.

“The electrocardiogram,” he said. “You told me it was normal.”

“It was.”

“You’d better take another look.”

Puzzled, she opened the chart to the EKG, the electrical tracing of Ellen’s heart. The first detail she noted was her own initials, written at the top, signifying that she’d seen the page. Next she scanned the tracing. For a solid minute she stared at the series of twelve black squiggles, unable to believe what she was seeing. The pattern was unmistakable. Even a third-year medical student could have made the diagnosis.

“That’s why she died, Kate,” Guy said.

“But— This is impossible!” she blurted. “I couldn’t have made a mistake like this!”

Guy didn’t answer. He simply looked away—an act more telling than anything he could have said.

“Guy, you know me,” she protested. “You know I wouldn’t miss something like—”

“It’s right there in black and white. For God’s sake, your initials are on the damn thing!”

They stared at each other, both of them shocked by the harshness of his voice.

“I’m sorry,” he apologized at last. Suddenly agitated, he turned and clawed his fingers through his hair. “Dear God. She’d had a heart attack. A heart attack. And we took her to surgery.” He gave Kate a look of utter misery. “I guess that means we killed her.”

* * *

“IT’S AN OBVIOUS case of malpractice.”

Attorney David Ransom closed the file labeled O’Brien, Ellen, and looked across the broad teak desk at his clients. If he had to choose one word to describe Patrick and Mary O’Brien, it would be gray. Gray hair, gray faces, gray clothes. Patrick was wearing a dull tweed jacket that had long ago sagged into shapelessness. Mary wore a dress in a black-and-white print that seemed to blend together into a drab monochrome.