Code Terror

Prologue

The Iranian made explosively formed projectile tore through the floorboard of the rapidly moving limousine despite its hardening against attack. The white-hot disk of titanium continued through the roof of the vehicle, as the entire vehicle leapt off the ground with the kinetic energy from an exploding five hundred pound iron bomb buried in the roadbed. The legs and lower torso of the Muslim cleric in the backseat were instantly transformed into a pink cloud of strawberry mist as the expanding gases ripped the top of the limousine from the vehicle and peeled it forward like the lid on a can of sardines. The outstretched arms, shoulders, and head of the Muslim cleric cart-wheeled out of the newly installed moon roof, as the vehicle continued upward, and forwards twenty meters down the highway. The cleric's turban miraculously stayed on the now lifeless head as it twirled rapidly backwards, end over end, in the nitrate laden smoke like some Chinese firework. The outstretched arms provided stabilization until the propelling energy was exhausted and it fell to the dusty road. The torso bounced twice before coming to rest with the smashed face pointing skyward, and the crown pointing to Mecca. A fitting end, for a bloodthirsty megalomaniac, and purveyor of misery throughout the globe.

This solitary act of violence was in retribution for countless acts of violence already perpetrated on humanity, and untold acts in the future. The geopolitical course of history was profoundly knocked off course by this one event in way not seen since the Crusades in the Middle Ages. Two relatively powerless, yet passionate, men had done what an entire army was prevented from doing. Just like when David brought down Goliath with a small rock, and a handful of Mujahadeen defeated a major superpower, a well placed and timed asymmetrical strike set in motion a chain of events few could have predicted.

CHAPTER ONE

Blindsided

At 4:45 a.m. the telephone rang in the C.T. control booth in Bayside Memorial Hospital, a 100 bed facility in Florida’s extreme Southwestern section. The bone tired Ted Strickland groaned, and set down his half-empty styrofoam cup of cold, rancid, hospital coffee. He figured it was just the admin types wanting a guarantee that the C.T. scanner would be up and running by 7:00 am.

Strickland, he answered.

There you are, you son of a bitch, thought you could hide from me. Stop goofing off and get your ass back down to Main ten minutes ago, said Dr. Janice Riley, Chief Radiologist of the Southwest Florida Regional Medical Center.

What goofing off Janice, said Ted, I’ve been up all night changing an x-ray tube on the C.T. here. You know as well as I do it’s a twelve hour job.

I don’t care, I need your ass here NOW! And with that, Ted heard the line go dead.

Ted turned to Craig Nelson, his bio-med in training staffer and told him, Looks like you are going to have to finish up the calibration scans and put the covers back on by yourself Craig, think you can do that?

Sure Ted, piece of cake.

Great, don’t forget to run the QC phantom scans and get Dr. Bartlett to give you the high sign before you let the flood gates open up.

Copy that, Ted.

Ted dragged his six-foot-one inch frame off the stool he’d been perched on, and packed up his tool case before heading for his Jeep. He made the forty mile drive back to the 250 bed, Southwest Florida Regional Medical Center, or ‘Main’ as they called it, from the 100 bed Bayside Memorial Hospital, in twenty-six minutes flat. He was beginning to wish he hadn’t gone on that five mile run on the beach yesterday afternoon, just before his pager went off. He’d picked up a bit of a sunburn on top of his medium tan which added a bit of dehydration to the mix. He’d learned a long time ago to take advantage of lulls whenever they presented themselves, they never lasted very long.

When he got to the MRI section in the Diagnostic Imaging Department his acid reflux from the rancid coffee he’d been drinking all night came up in his throat as he spotted white coats overflowing out of the control room into the hallway.

My God, thought Ted to himself, this must be some production. Nothing like working in front of a ‘live audience’. Let's just hope everyone stays that way.

Ted fought his way through the sea of white coats to the MRI control console. There he found Dr. Janice Riley, Chief of Radiology, seated at the control console. This fact made Ted really apprehensive because she never drove the imaging equipment herself, preferring to shout orders at the poor Imaging technicians. Ted looked into the exam room on the other side of the floor to ceiling glass wall which separated the control area from the exam area, at the resting place for the 1.5 Tesla, superconducting magnet, in which a two-year-old infant boy was inserted. He had plastic anesthesia tubes running ten feet to a portable anesthesia cart just outside the magnetic field. If the cart was parked three feet closer the magnet was fully capable of picking up the cart, gas bottles and all, and slamming it into the magnet so fast you could miss it if you blinked. There was an anesthesiologist and nurse in the exam room, and more nurses, orderlies, residents, and imaging technicians than Ted had ever seen in one place at the same time in the control area. Ted had no idea what had gotten between Dr. Riley and her saddle blanket, but as he looked into the bore of the magnet an inkling of what might be a problem hit him immediately.

Janice Riley looked up as she heard Ted saying, make a hole people, as he fought his way forward.

Well, it’s about time you showed up, you are killing that poor kid on the exam table. I thought you tested this machine after the upgrade last week. Looks like you broke it. Some upgrade.

Well good morning to you too, Janice. If it was ‘broken’ after the upgrade, why did you sign off on the test scans?

Ted regretted saying this almost as soon as the words were out. Not because she didn’t have it coming, but because there were all these witnesses to her loss of face. She had the juice, and the ego, as all radiologists do, to get him fired if he pushed her too far.

That’s Doctor Riley to you dammit, now fix this freaking thing before you really kill this kid. We have to get spatial landmarks located in his brain right now because he is going straight to surgery from here. This piece of crap won’t tune and match and if it won’t, no scan, get it?

I think the reason it won’t tune and match is the stereotactic frame you’ve got his head chucked up in. There must be ferrous metal in that frame. Where did it come from, I’ve never seen it in the department before?

You’ve never seen it because I just purchased it, and for your information, the halo ring is all plastic, no metal, guess again.

What about the clamping screws?

They are brass, satisfied?

Ted was very skeptical. This machine had been upgraded less than two weeks ago, tested thoroughly, and had been back in service putting out fabulous images since then.

Back him out of the bore for a minute.

What the hell do you think you’re doing? We don’t have time to screw around while you scratch your ass!

Just do it Janice.

How dare you address me like this, I’ll have your head on a ……..

Before she could finish, Ted bolted for the exam room and grabbed the release handle at the foot of the exam couch which allowed him to roll the curved platter on which the infant rested out of the bore. Then he went to a side cabinet and grabbed the plastic QC phantom and put it in the isocenter of the bore from the back side of the magnet. He hurdled the anesthesia hoses as he ran back to the control area.

Start the tune and match sequence, he commanded.

The only reason Janice Riley complied is that she wanted the satisfaction of rubbing Ted’s nose in the fact that the imager was really broken. The distinctive gradient coil thumps sounded off. One group, then a pause, then another set of thumps, then a pause, while the computer tuned the gradient coils and the radio-frequency circuits for maximum signal strength. The console then displayed a message, Push Start to Initiate Scan. Ted had never seen anything so sweet in his entire life.

The imager is fine, your stereotactic frame is the problem.

That, that can’t be, Janice said, and even if it can, it won’t get this kid imaged and without the frame the surgeons won’t have the reference landmarks they need to locate the tumor.

Wait one.

Ted went back into the exam area, turned on the laser locators inside the magnet bore to mark the isocenter of the magnet. He once again disengaged the table locking handle and rolled the child slowly forward until just the crown of his head was under the laser line, above the halo ring of the stereotactic frame. He released the clamp and hurdled the hoses again on his way back to the control console.

Dr. Riley was beginning to calm down a little now, and initiated the sequence without so much as a word. The thumping began again, and once again the computer screen prompted to begin the scan. Ted made his third sprint into the room, retrieved the phantom from the back of the magnet and rolled the table into the original scan plane just above the stereotactic frame.

Don’t tune and match again, just start the scan now, he told Riley as he returned.

But the images will be affected!

Not by much, the tune and match caught the density of the crown of his head, besides, what have you got to lose?

Again, no response, but Riley reached forward and pressed the Start Scan button. Within seconds the magnet was thumping like a base drum. Ten seconds later the first plane’s image painted into view and the image quality was on a par with what used to be normal before the upgrade. Without a word to anyone, Janice Riley stood up, pointed to the MRI imaging technician she had displaced, then to the chair in front of the console, and strode off towards the reading room where she could monitor the same images on the doctor’s console slaved to the exam console.

An orderly in the back of the pack of people standing next to one of the radiology techs asked, Why does Doctor Riley have such a hard-on for Ted? She should be thanking him, not treating him like a moron.

The technician chuckled and said, Well, I’m not sure, but it could have something to do with Ted walking in on Doctor Riley and DeMarcus Webb, the Lead CT Tech ‘do’in the dirty’ in the linen closet about a month ago.

You’re kidding, ‘Doctor J’ and ‘De-Marvel-ous’? No way!

Oh yeah, way!

But she’s married with two kids!

Yeah, but De-Marvel-ous is packin’ that six-cell flashlight ‘stress reliever’, and Dr. J is wrapped tighter than any three people you know, you know?

Unreal, who all knows about it?

Just about everybody; with the possible exception of you.

So she’s pissed Ted told somebody?

I have it on absolute authority that Ted never breathed a word about it.

Then who let the cat out of the bag?

The junior assistant CT tech. When she needed help transferring a patient about to be scanned from a gurney, and DeMarcus was AWOL, Ted offered to help. There was no bottom sheet on the gurney to lift the patient with so she and Ted went to the linen closet to get one. The tech knew they are on the top shelf and she’d need Ted to reach it up that high. Well she opened the door and was through it as Ted was reaching for the light switch. He flipped on the light at the exact moment that the tech screamed when she plowed right into Dr. J and DeMarcus all hot and sweaty. She said they never missed a beat, just kept right on getting’ with it.

No!

Yep, so Ted calmly reached up and grabbed a sheet, just like nothing was going on, and flipped off the light, and closed the door, just like nothing had happened.

What about the Tech?

Oh, she was nothing but a ‘vapor trail’ at this point.

I’ve heard rumors about Ted’s cool. Is it true he used to be a Navy Seal?

That would be a fact. He got a little old, and slow, for the Teams and decided he’d rather fix things than blow them up.

Ted stayed until all the images were reconstructed and photographed, then decided to check in downstairs with his admin assistant before he went home to crash. The looks and the almost smiles of the white coats were all the reward Ted needed, and certainly all he would get. One had to derive one’s job satisfaction from the knowledge that lives were saved by the equipment and he and his staff were the equipment doctors. In any bio-med engineer’s mind this made them equals with the gods known as physicians.

Ted stepped off the elevator and crossed the hallway to his department located in the basement. Trish Mathews, his admin, greeted him with a smile and, I heard you played a ‘double-header’, Craig told me about your summons to ‘Mount Janice’, she said, giggling at the not so private pun, how did it go?

Let’s just say it is Christians one, lions nothing.

Killer, but before you get comfortable, check your pager battery, it must be dead. You have another command performance, this time in Harry Carlson’s office, and you are late.

When it rains, it pours, Ted said pulling his pager off his belt and putting it in the charger rack by the door. Surely Janice couldn’t have gotten him fired this quick, could she?

CHAPTER TWO

Barking Up The Wrong Tree

Go on in Ted, Harry’s expecting you, said Alma Waters in Harry Carlson’s outer office. Harry was the CEO of the three facility regional group owned and operated by Americana Healthcare System, a national hospital chain.

Thanks Alma, said Ted as he opened the door to the paneled office on the top floor of the hospital. Before him was a breathtaking Westerly view of Marco Island on a clear, sunny morning. Ted could see the cauliflower like fingers of land and man-made canals with boats of every description moored in the backyards of very up-scale homes. Harry was seated at the head of a polished oak conference table and a suited man Ted didn’t recognize was on his left.

Ted, glad you could get free to join us, Harry said without a trace of sarcasm. I heard about the dustup with Riley just now. Great work on your part, but try to stay out of Janice’s sights for a while if you can.

No problem there Harry, said Ted with just a trace of a smile, somewhat embarrassed with his disheveled appearance, and day old growth of beard.

This is Special Agent Stephen Reynolds with the DEA, pointing at the stranger in the suit. Agent Reynolds, Ted Strickland, our Chief of Bio-Medical Service. Ted can fill you in on all the strange ‘equipment failures’ we’ve had in the past few months, and by ‘failures’, I mean deliberate acts of sabotage.

Pleased to meet you Mr. Strickland, but as I was telling Harry just before you came in, the DEA is not interested in any equipment sabotage, our focus is the employee drug problem you have here at the hospital. You’ll need to address this sabotage issue to the FBI or the local police.

And as I was telling you before Ted came in, there is no way I’m about to allow you to put spies inside my hospital to snoop on the employees. If, and I’m not convinced we do, have a significant drug using population among our employees, you can catch them off the hospital premises. I won’t be a party to witch-hunts.

If the problem gets any worse Mr. Carlson, you may have to eat those words.

Perhaps Agent Reynolds, but until then, good day.

Agent Reynolds rose from his chair and left the room without another word.

Did you tell him we’ve already informed Sheriff Swade?

Yes, and he knows full well Jim Swade doesn’t have the resources to begin to address the problem. I’ve already put in a call to the FBI. They said unless Homeland Security or immediate loss of life is involved they’ll get to us when they can.

Well, sabotaged medical imaging equipment should qualify as potentially life threatening, at least indirectly, right?

Not in the Feebs minds. Unless there are bullet holes and blood stains they view this as a matter for the locals. By the way, I’m sorry I doubted your department in the past. Until you came up with the hard evidence of sabotage I’m ashamed to admit that I was having doubts about your staff’s ability to keep the equipment running smoothly.

Harry was referring to the handful of roofing nails he’d found in the high voltage transformer tank in the Cardiac Cath Lab equipment room. Ted had to admit this was a diabolical means of destroying an $80,000.00 piece of vital gear. Jim Gray, his Cath Lab specialist had notified him of the situation early one morning when the Cardiologist had stepped on the fluoroscopy foot pedal to place a catheter and instead of getting an image he heard a monumental boom in the equipment room as the four foot by two foot oil-filled high-voltage transformer shorted out at 165,000 volts and jumped two inches off the floor just before the 480 volt, 100 amp, three-phase circuit breaker popped.

A failure of this nature was not statistically impossible, but highly improbable. Once in service, those tanks were tough as nails; except when the nails were laying across the copper windings down inside the oil.

Ted had immediately smelled a rat. Too many inexplicable failures had occurred in too short a time frame to be spontaneous. He’d ordered Jim Gray and his newbie Craig Nelson to pump all the oil out of the tank to inspect the interior. They weren’t too thrilled about this but Ted would have none of their bitching. Two 55-gallon drums later they found what was left of a handful of roofing nails. Most had virtually vaporized. These were the ones laying across the copper windings. However, two nails had rolled off the windings and gone to the bottom of the tank, where they remained intact and identifiable. Of course the oil had made the prospect of getting fingerprints impossible, besides, every room in the imaging department was chock full of boxes of latex gloves for the taking, and nobody ever thought twice about someone wearing them. Even the bio-med staff wore them to combat the risk of infection and AIDS as dried human blood could be found lurking inside crevices of any piece of imaging gear in the department. Whoever was responsible was damn smart, but why would any sane person want to do this?

Then there was the dust-bunny incident.

CHAPTER THREE

Fuzzy Feelings

As any Engineer will tell you, intermittent problems are the hardest ones to fix. It is impossible to analyze a failure if the equipment isn’t currently failing when you are present. Klaus Hoebner had been fighting a problem with the CT scanner at Bayside Memorial for weeks. Every time he’d get the call from the imaging techs he’d rush out there, and every time they played the same story, the scanner had just taken off and ripped off a full slice scan on its own. Sometimes they said nobody was even in the control booth. While the equipment remained intact, and ran just fine on command, they were tired of getting radiation readings on their film badges which had to be explained to the Radiation Safety Officer, Dr. Oberholser, who made them get blood tests to check for cell damage. Klaus could never duplicate the issue. He removed every cover, checked every wiring connection, and had even replaced some of the likely control circuit boards which theoretically could have caused the phantom scans.

Finally Klaus threw up his hands, swallowed his German pride and asked Ted for some help. Ted knew Klaus was incredibly smart, had played all the right percentages, and if he could not find it, the problem had to be hiding in plain sight. Late one evening, which is the ONLY time you can take a functioning piece of imaging gear offline, Ted and Klaus had all the covers in both the imaging room, the control booth, and the computer/x-ray generator room off looking for the issue, when Dr. Matthew Steen, the Collier County Medical Examiner, slipped in the control booth door and spoke to Ted in a hushed voice.

Is the CT capable of producing an image right now?, whispered Steen.

Well yes, even if you don’t actually want one, quipped Ted.

Then I need it right now. It will only take a couple of minutes, then you can have it back.

Dr. Steen, it will take us thirty minutes just to put all the covers back on even in just the exam room so the patient won’t freak out when the CT gantry takes off and starts rotating around them.

That won’t be a problem; then I can have it, right?

Well sure, I guess, only for you Dr. Steen.

I’ll be back shortly.

Less than two minutes later the four foot wide door to the exam room opened and Dr Steen pushed an overflowing laundry hamper through the door then closed and locked it. He came into the control booth and closed and locked the door just after Dr. Bartlett, the staff Radiologist slipped through.

Ted and Klaus stood dumbfounded as the Medical Examiner and the Radiologist started tossing towels and sheets haphazardly out of the hamper onto the floor. Then they reached inside and lifted out the most precious little eight year old girl out of the bottom of the hamper and placed her on the CT exam couch. She looked like a sleeping angel, but she was quite dead.

Dr. Bartlett drove the exam table into the CT bore, stopping with the laser right on the tip of that doll-like nose, then turned, and strode rapidly into the control booth.

Ted, do you think you could set up and give us five millimeter slices from the current position down through the cervical spine?, said Bartlett.

Sure, but don’t you want to get one of the techs to do it?

Dr. Steen said, We don’t really want to involve any more people in this than we have to. The little girl’s parents are sitting out in the hallway. They brought her into the Emergency Room saying she had spontaneously stopped breathing, yet the E.R. docs couldn’t find anything wrong with her other than the fact she had obviously expired.

Well OK then, here we go.

Five minutes later, once the scans were finished, Dr.s Bartlett and Steen were huddled over the image display.

Look there, Bartlett said, the hyoid bone is crushed.

I thought so, said Steen, the father must have wrapped a towel over her throat to keep from leaving strangulation marks on her throat, but the poetical hemorrhaging in her eyes gave him away. That spells pre-meditation, we have enough evidence to convict him of murder one.

Ted and Klaus were speechless. The silence between the four of them was deafening as they gazed out at the tiny, innocent looking, china doll without a mark on her lay in repose. Just then the scanner took off and took one last image on its own, as if to store a keepsake of the beauty within its grasp.

Ted and Klaus worked on into the night. At 10:30 pm Ted was about ready to give up and pull the plug because it would take another hour to put all the covers back on and perform the QC scans so they could use the imager on third shift or latest by 7 am in the morning.

Ted looked around and finally his gaze settled upon the keyboard used to input patient data which appeared on every image slice in the exam.

Klaus, hand me an Allen wrench, I want to pull the keyboard shroud off.

Sure, but why? The only thing under there is a standard computer keyboard and I pull it off every quarter to vacuum it out.

Humor me.

As Ted was loosening the Allen screws on the shroud the scanner took off and scanned the empty bore. This happened three more times before Ted got all six screws out. Under the cover, wedged between the Control key and the Shift key was a tiny dust-bunny.

There’s your trouble, said Ted.

How is that possible? The scans are initiated by the two stage standard x-ray 'pickle' button on the coiled cord.

Yep, every tech in the building uses the pickle switch because they can stand up and look through the leaded glass to make sure the patient is holding still. Every x-ray machine has one and the CT manufacturers didn’t want to break the paradigm, but there is a secret handshake keystroke combination which will also initiate a scan. Read the manufacturer’s manual, it’s in there.

Klaus spent the rest of the night talking to himself, unable to believe he’d missed this on his last PM cycle. Ted was also skeptical about Klaus having missed it. Klaus had the most meticulous work habits of anyone on his staff. His German heritage made him precise, detail oriented, and although somewhat slow, very, very thorough. Ted noted that none of the other keys had any sign of dust buildup under them. That’s because Klaus had done a thorough job of vacuuming it out. This smelled awfully suspicious.

CHAPTER FOUR

Cat And Mouse

It was just past midnight at the Raceway Diner, on State Highway 42, when Tompson Hughes and Gerald Spinks sat down for their lunch. Both were longtime employees of Saul Meyer, owner of Meyer Medical Supply. The business was a dealer/distributorship for large format imaging film, photographic chemicals, liquid Helium and liquid Nitrogen for MRI superconducting magnet cooling, and also performed light maintenance. Lately, Saul Meyer had taken on a whole new line of supplies, catering to the personal wants and needs of the hospital staffs on their delivery routes. Tom and Gerry could eat their nightly meal at their leisure as long as they made it to their assigned hospitals well before the morning hospital shift change at 7am.

Hey Tom, how you be?, shouted Gerald as he saw Tompson approaching.

Whas-up Gerry?

Figured you was gwan up Fort Myers way tonight.

Naw, Saul said to hit Marco Main again tonight since the take there is so lucra-tive right now.

No shit, you must be movin’ a lot of product, eh?

You might sezs dat. Dem lily-white bitches sho-nuff like the blow. Dey even do’in it in the smoking gazebo ‘stead of nicotine.

Better tell dem ho’s to watch demselves. Dey get caught do’in dat shit and dez gonna rat us out to the man.

"Yeah man, I’m down wit dat. So where you head’in off to dis starry night?

Bays-whore Memorial next on ma list. Gotta lotta word-o-mouth ginn’in down dere. New cuss-a-mers ever time I rolls up. Tis a wonder anybody survives a stay in dat joint, cause the help is so fucked-up on product.

Any body sub-contracting yet?

"Oh hell yeah, dey