the airway prior to intubation; and the drugs that would put her under for the duration of the surgery.
The drugs, of course, were the most important element, and he had them all at hand. Fentanyl, an opioid analgesic eighty times more potent than morphine, would be used as the primary sedative, followed immediately by vecuronium, a paralytic compound. Both were contained in 12ml disposable syringes. Approximately thirty seconds after administering the vecuronium, Craig would intubate Fitzgerald. At that point, all he had to do was monitor her vitals. Qureshi would take care of the rest.
A pericardial window was a fairly simple procedure, but like any surgical procedure, there were always risks. To keep those risks to a minimum, they would do everything in a predetermined order, following the established protocols. Surgery was much like a court decision; everything hinged on precedence. If something had worked in the past, it would likely be used in the future. The pneumothorax was a minor inconvenience, but Qureshi had handled it well; Craig had already noted the quality of the work. He was pleased to see that the lesser injury had already been taken care of, because waiting to start on the window clearly wasn’t an option. According to Qureshi, her blood pressure had dropped dramatically over the past several hours.
Now, as Craig screwed the syringe of fentanyl into the port in Fitzgerald’s left arm, he checked the monitors and saw that her BP was eighty-three over forty, indicating that the blood filling the pericardial sac was beginning to put a great deal of pressure on her heart, decreasing its ability to pump blood to other parts of the body. Qureshi had been right when he’d remarked on the urgency of the situation. If they were to walk away now, Fitzgerald would probably go into cardiogenic shock in the next few hours. Once the syringe of fentanyl was secure, he pushed down the plunger, marking the time and dosage. Unscrewing the empty syringe, he replaced it with the vecuronium, then did the same thing. Unscrewing it, he watched and waited. Once twenty-five seconds had elapsed, he touched Fitzgerald’s eyelids. Nothing happened; she didn’t react at all.
Looking up at Qureshi, Craig nodded once, then moved quickly to the head of the table. Standing behind Fitzgerald, he reached for the endotracheal tube, grabbing it with his right hand. Adjusting her head slightly, tipping it back, he opened her slack mouth and inserted the tube. He reached out with his left hand for the laryngoscope, which—like the endotracheal tube, or ETT—was smeared with lubricating jelly. Using the lighted mirror on the end to ascertain his progress, he moved the epiglottis out of the way, then slid the plastic tube down her trachea, stopping a few centimeters short of the point where the trachea split into the lungs. When he was done, approximately 4 inches of the tube protruded from her mouth, the end marked by a connection point. To this, he attached the clear plastic tubes that were already connected to the ventilator. Then he taped the ETT into place. Checking the monitors, he saw that the numbers were falling into an acceptable range.
“That’s it,” he said, stepping back from the table. Mengal had already moved in and was practically leaning over Fitzgerald, but Craig ignored him; his words were intended for Qureshi alone. “She’s all yours.”
Qureshi nodded and shot a practiced glance at the monitors. Then he approached the table. Fitzgerald was wearing a loose-fitting surgical blouse. The material was already pushed up to the lower curve of her breasts to expose her abdomen, which Craig had needed to see while putting her under. The rate of abdominal rise and fall was a good indication of the patient’s response to the intravenous drugs he’d administered. With practiced speed, Qureshi applied Betadine to the exposed abdomen with a few disposable swabs, turning Fitzgerald’s skin a sickly shade of orange red. That done, he draped sterile towels over most of the area, leaving only a small patch of skin exposed. As the surgeon’s fingers danced over the stainless-steel tray, searching for the appropriate tool, Craig tried to ignore what he was feeling inside. He tried to remind himself that at the end of the day, Brynn Fitzgerald was just another patient, a person in need of medical attention, but it just wasn’t working. It didn’t matter how he looked at it, because he couldn’t get his mind around her title. He couldn’t forget about all those magazine covers, about the dozens of times he’d seen her on the news. He just couldn’t forget. . . . Qureshi had found the scalpel he needed, a long blade with a rounded head, mounted in a sturdy titanium No. 4 handle. Craig couldn’t help but wince as the Pakistani lifted the scalpel in his right hand, the razor-sharp steel flashing under the Burton lamps. He automatically adopted the palmar grip, which was ideal for larger, deeper cuts. Using the fingers of his left hand, he probed for the base of Fitzgerald’s sternum, then lowered the long blade to her skin, preparing to make the subxiphoid incision. A few seconds later it was done. There was little blood, but Craig had seen this done often enough that the absence of blood no longer surprised him. Qureshi used a pair of retractors to spread the 2-inch incision, then locked them into place. The next part was the worst, at least for Craig, and he had to turn away as Qureshi picked up a 16-gauge needle. To Craig, the surgical instrument looked like a long roofing nail, much like the kind he’d used when working construction in his teens. He’d never been able to dismiss the mental comparison.
He was still looking away as Qureshi slid the tip of the needle into the small incision. Then, moving his arm slowly but steadily forward, the Pakistani pushed it in, angling the point up into Brynn Fitzgerald’s heart.
CHAPTER 28
CARTAGENA
It was just after two in the afternoon as Kealey stepped outside, holding Naomi’s Globalstar sat phone and a glass of iced tea. The sky was a clear, brilliant blue, not a cloud in sight, and it was extremely hot, at least 90 degrees Fahrenheit and climbing. The second he closed the French doors behind him, he could feel the heat enveloping him, the air so heavy it seemed to cling to his exposed skin. He could hear the traffic moving on the other side of the trees, but it wasn’t too bad at this time of day. As he crossed the grass, moving past the aluminum table, toward the trees, he looked back at the house, his eyes flickering up to the second-floor balcony. No one was there. Satisfied, he punched in the number to Jonathan Harper’s office, adjusted the antennae, and lifted the phone to his ear, waiting for the satellite above to make the connection. One of the watchers from Madrid—the last member of Petain’s team who was still in-country—had just left, having dropped off their bags and passports, all of which they’d left at the hotel the previous day. Kealey had gone through all of it, and everything seemed to be in order. He would have preferred to wait for new passports, not wanting to use the same ones they’d flown in with, but he and Petain didn’t have time to wait. The day before, Amari Saifi had made his ransom demands public through a videotape sent to al-Jazeera’s headquarters in Doha. Now the whole world knew what the U.S. government had discovered barely twenty-four hours earlier, and so far, the fallout had been nothing short of catastrophic. Harper had said as much the night before, and Kealey, clicking through the various news channels that morning, had seen what he was talking about. The media speculation had been wild to begin with, but now, with this new development, almost nothing else was touched on. Even the burgeoning conflict between India and Pakistan wasn’t enough to derail the networks’ intense focus on the abduction of Brynn Fitzgerald, as well as the murky background of the man who had just eclipsed Osama bin Laden as the world’s most famous terrorist. Lee Patterson, the U.S. ambassador to Pakistan, had been buried the day before at Arlington National Cemetery, with full military honors. According to MSNBC, Patterson had served as a navy officer for six years before resigning his commission to join the Foreign Service. More than 600 people had attended his funeral, including several well- known businessmen, a former secretary of state, and the president of the United States, David Brenneman. The anchor went on to recap the ambush on Airport Road, noting the fact that the FBI was currently conducting an extensive extraterritorial investigation in Rawalpindi.
Much to Kealey’s relief, there was no mention of the name Benazir Mengal. Although he’d informed Harper of Mengal’s ties to the Algerian only the day before, Saifi’s name had been in circulation at the Agency for nearly two weeks, plenty of time for it to leak. Kealey was surprised it had taken this long to come out, but with the release of the tape, it was unavoidable. A quick check of the other news channels had been enough to confirm that Mengal’s involvement had yet to be revealed in the media.
Of all the major networks, only CNN had made an effort to report on the escalating situation in Kashmir. The network had dispatched Christiane Amanpour, its chief international correspondent, to Udhampur, where she was reporting from the Indian Army’s Northern Command headquarters. Kealey only caught the tail end of her report, but it was clear that the situation was escalating to the point of no return. More than 50,000 troops were now amassed in the region, in addition to an unknown number of Kashmiri insurgents, the vast majority of whom were affiliated with Pakistan’s Inter-Services Intelligence. Shots had already been exchanged, and it looked as though
