THE MAN EXAMINED THE INCISION THAT RAN ALONG THE RESOURCE’S lower spine from L2 to the sacrum. It was a very fine piece of work, the kind he had been so well appreciated for in medical school—back before the unpleasantness began.
The newspapers had nicknamed him the Surgeon. He liked the name. And as he gazed down, he found it particularly appropriate. He’d defined the anatomy perfectly. First, a long vertical incision from the reference point along the spinal process, a single steady stroke through the skin. Next, he had extended the incision down into the subcutaneous tissue, carrying it as far as the fascia, clamping, dividing, and ligating the larger vessels with 3-0 vicryl. He’d opened the fascia, then used a periosteal elevator to strip the muscle from the spinous processes and laminae. He’d been enjoying the work so much that he had taken more time at it than intended. The paralyzing effects of the succinyl choline had faded, and there had been rather a lot of struggling and noise at this point, yet his tie work remained as fastidious as a seamstress’s. As he cleared the soft tissue with a curette, the spinal column gradually revealed itself, grayish white against the bright red of the surrounding flesh.
The Surgeon plucked another self-retaining retractor from the instrument bin, then stood back to examine the incision. He was pleased: it was a textbook job, tight at the corners and spreading out slightly toward the middle. He could see everything: the nerves, the vessels, all the marvelous inner architecture. Beyond the lamina and ligamentum flavum, he could make out the transparent dura of the spinal cord. Within, bluish spinal fluid pulsed in time to the respiration of the resource. His pulse quickened as he watched the fluid bathe the cauda equina. It was undoubtedly his finest incision to date.
Surgery, he reflected, was more an art form than a science, requiring patience, creativity, intuition, and a steady hand. There was very little ratiocination involved; very little intellect came into play. It was an activity at once physical and creative, like painting or sculpture. He would have been a good artist—had he chosen that route. But of course, there would be time; there would be time…
He thought back once again to medical school. Now that the anatomy had been defined, the next step would normally be to define the pathology, then correct that pathology. But, of course, this was the point at which his work departed from the course of a normal operation and became something closer to an autopsy.
He looked back toward the nearby stand, making sure that everything he needed for the excision—the chisels, diamond burr drill, bone wax—was ready. Then he looked at the surrounding monitors. Although, most regrettably, the resource had slipped into unconsciousness, the vitals were still strong. New strides could not be taken, but the extraction and preparation should be successful nonetheless.
Turning toward the Versed drip inserted into the saline bag hung from the gurney, he turned the plastic stopcock to stop the flow: tranquilization, like the intubation, was no longer necessary. The trick now would be to keep the resource alive as far into the surgery as possible. There was still much to do, starting with the bony dissection: the removal of the lamina with a Kerrison rongeur. The goal at this point was to have the vitals still detectable when the operation was complete, with the cauda equina removed and lying intact in the special chilled cradle he had designed to receive it. He had reached that goal only twice before—with the slender young woman and the policeman—but this time he felt a swell of confidence in himself and his skills. He knew that he would achieve it again.
So far, everything had gone according to plan. The great detective, Pendergast, whom he had so feared, had proven less than formidable. Using one of the many traps in this strange old house against the agent had proven ridiculously easy. The others were minor irritants only. He had removed them all, swept them aside with so little effort it was almost risible. In fact it was risible, how pathetic they all were. The colossal stupidity of the police, the moronic Museum officials: how delightful it had all been, how very diverting. There was a certain justice in the situation, a justice that only he could appreciate.
And now he had almost achieved his goal. Almost. After these three had been processed, he felt sure he would be there. And how ironic it was that it would be these three, of all people, who helped him reach it…
He smiled slightly as he bent down to set another self-retaining retractor into place. And that was when he saw a small movement at the extreme edge of his peripheral vision.