Coded to Kill
In the wake of the COVID-19 pandemic, U.S. government is poised to adopt a nationwide system for Electronic Health Records that uses the latest advances in advanced artificial intelligence to immediately identify emerging diseases and vastly improve the delivery of care. But what if this historic breakthrough to save lives is also being used as a killing machine? And what if one of the first assassination targets is a presidential candidate?
These are questions that fuel Coded to Kill, the debut techno-medical thriller by Marschall Runge, M.D., whose ripped from the deadlines premise explores the great promise yet all-too-real perils of high-tech innovation. Drawing on his long career as a cardiologist, and his current position as CEO of Michigan Medicine and Dean of the Dean of University of Michigan’s Medical School, Runge tells a story of murder, mystery, politics, and even a little romance. This exclusive RealClearBooks excerpt features scenes from the opening pages of Coded to Kill.
Chapter 1
Sunday, May 8
6:00 AM
Durham, North Carolina
Jesse Gutierrez was the last man standing from the construction crew now almost as invisible as the high-tech bunker they had built. But his time was running out—a team in that underground facility was recording his every move.
Gutierrez’s commute to Drexel Memorial Hospital took him over a backcountry two-lane bridge that spanned a stretch of deep water. The investigators would find multiple contributing factors. Gutierrez worked long hours and was probably fatigued. His cell phone would show that he had received a robocall which would appear to have originated from Malaysia just moments before impact. The accident reconstruction team would conclude that the curving road, dew-slickened pavement, sun in his eyes, and distraction of his phone caused Gutierrez to crash into the guardrail.
What they wouldn’t find was that the guardrail had been modified to crumble through the application of organic acids and other reactants.
And they would never learn of the panel truck, commanded by an expert driver who knew how to force another vehicle off the road without making contact. The computer models said that as long as the truck swerved at just the right time, Gutierrez’s car would crash through the weakened guardrail, clear the bridge, and fall into the water, sinking to the deep bottom in ninety-three seconds.
The highly choreographed attack on Jesse Gutierrez was complicated, but worth it given the enormous stakes.
˜
A satellite 430 miles above beamed real-time images to the underground conference room with large monitors on the walls. Hugh Torrence rarely attended terminations. His presence was further evidence of its importance.
Decades of experience in the military—and later the NSA—had honed Torrence’s attention to detail. He considered every possible outcome of an operation, analyzed the results, then rethought the plan. There was no substitute for disaster awareness and disaster mitigation in his line of work. Evil abounded. On this brisk Sunday morning, he was ready, as always.
Twenty-three-year-old IT wunderkind Benny Rasinko adjusted the images on the screen from his black Aeron chair. Beside him stood Torrence’s unflappable second in command, Hasan Saied.
At precisely 6 AM, a muscular man wearing a brown Drexel Memorial Hospital polo and blue jeans appeared on the screen. He exited the front door of his small townhouse and climbed into a blue Honda Civic.
“Subject is en route to Drexel,” Benny announced.
Two minutes later, Gutierrez pulled onto a two-lane blacktop. He had so many questions, and the peaceful drive down a rural highway gave him time to think. His mind kept returning to the construction job he’d worked on a year ago, building a tricked-out underground bunker in northern Virginia
His misgivings intensified as he learned that other workers—all, like him, unmarried Spanish-speaking men—had been meeting untimely ends. Drunk-driving accidents, barroom fights, drownings and drug overdoses. Each one seemed legit, but so many? A year ago, he wouldn’t have cared. He hadn’t cared much about anything after the meaningless carnage he’d seen in Afghanistan as a member of the Special Forces. But he had slowly rebuilt his life after leaving the service, taking on any job or opportunity that came his way, and his old instincts began to kick in. Building an underground bunker in the middle of nowhere made no sense. Nor did the passing mention of Drexel Hospital and electronic health records by the boss of that job—a sixty-something man known as El Jefe. He wondered, is that the key to those deaths?, and his own fate.
His antennae started pinging on high alert a few days before when he sighted a familiar face across the hospital parking lot: Dr. Mason Fischer. They went way back. No way Fischer was at Drexel by accident.
“Subject is two miles from Jordan Lake Bridge,” Benny called out. Torrence glanced at Benny, saw the boy’s energy drink sitting nakedly on the workstation, and placed it on a coaster before looking back to the screen.
˜
On any other day, the oversized panel truck tailgating his car would have irritated Gutierrez. Damned civilians. But not today. He considered slowing down just to annoy the jerk, but decided, Why bother? His phone rang. As he looked down to grab it, the panel truck whipped out across the double yellow line. What the hell? The truck was beside him in the oncoming lane as they crossed a bridge.
Suddenly it swerved toward him once, then twice. Gutierrez was all instinct and adrenaline now. The guardrail would save him. He’d slide into it at twenty-five-miles-per-hour, puncture the airbag, grab his Sig Sauer P226, and see if the bastard wanted to dance.
He slammed on the brakes, but instead of stopping his motion, the guardrail gave way like a bullfighter’s cape.
His head hit the steering wheel, and the Honda plunged into the water.
The guardrail on the north side of the bridge, where the acid had been applied, was in shambles. The Honda Civic was no longer in sight, sinking to the bottom of the lake. The panel truck moved slowly, then accelerated off the bridge. A mile away, an empty eighteen-wheeler waited to swallow it. No record of it would ever exist. “Operation complete,” Benny declared. Torrence smiled.
˜
What Torrence and crew couldn’t see was the small boat underneath the bridge, where a man was sleeping amidst the sloshing remnants of a Coors Light twelve-pack and a fifth of Old Crow before a violent splash awakened him.
The man considered doing nothing; every movement caused a ripple of pain that intensified the throbbing in his head. He heard a car door slam, an engine rev, and tires squeal from above. They’re going for help, he thought, and don’t need me.
Then he saw the black car beginning to sink and the outline of a man, solid and immobile. His conscience kicked in. He jumped in the water, swam to the car, unlocked the door, and grabbed for the seat belt. He found the latch and unsnapped it. The victim slid out with little effort. The strength that comes with panic enabled him to drag the victim towards the shore. Another creaking movement and the car turned downward. In five seconds, it was gone. The vortex nearly sucked them both down.
The victim was badly injured. His right leg dragged at an awkward angle. He moaned indecipherable words. The deep gash on his forehead gushed. His savior gently laid him on a flat spot that some fisherman had cleared out. He removed his shirt, ripping off a sleeve to make a bandage for the man’s head. He couldn’t find his cell phone. He scrabbled up the bank in time to see a car speed by. So did another, and another, until an elderly farmer in a pickup full of vegetables pulled over. The farmer had a phone. In minutes, the ambulance arrived and soon raced away, its lights flashing and sirens screaming. …
˜
Gutierrez was still unconscious when the ambulance reached Drexel’s emergency room. His heart was racing, his blood pressure perilously low. His ribs were broken, his femur shattered. Doctors, nurses, and technicians descended upon him in Trauma Room One, working with crisp efficiency.
In an instant, his clothes were cut off, and the blood-soaked bandages were removed. The cuts on his forehead and deep wounds on his right leg were scrubbed clean with Betadine and re-bandaged. Anxious residents and nurses who weren’t assigned to his case peered into the room before huddling in the corridor as they talked about his accident. It was a bad one.
“He works in Physical Plant,” said one nurse. “One of the guys down there said he’s working full time and trying to get a voc-tech degree. Now this.”
“Scary,” said Dr. Carrie Mumsford, a resident physician. “Could be any of us, as little rest as we get. I was still half asleep when I hit the road this morning.”
An emergency medicine resident rushed out of Trauma Room One and was immediately collared by the others.
“What’s the story?” Carrie demanded.
“Bad. The attending says it’s touch and go. He’s bleeding internally, but they can’t figure out where. His leg is mangled, maybe an artery was severed. The EHR shows some sort of weird rhythm on his EKG. Are any of the cardiologists down here?”
“There’s an acute MI in Critical Care Room Four, Mas ….” She stopped herself. “Dr. Fischer’s there,” said Carrie, referring to one of the newer cardiologists, Mason Fischer.
The emergency room resident hurried down the hall, an EKG in hand. …
The emergency room crew threw everything at Gutierrez, but for each step forward, he took two steps back, toward the grave. Within ten minutes, Gutierrez had his third cardiac arrest.
“It’s got to be the damned ventricular tachycardia,” yelled the ER attending physician. “Get a cardiologist. Now!”
“He’s here!” shouted the nurse in charge.
Dr. Mason Fischer read the initial EKG as he ran down the hall to Trauma Room One. It did not show ventricular tachycardia or any dangerous cardiac rhythm, just the very fast heart rate of a very stressed man with multiple injuries. A path to Gutierrez’s side cleared as he rushed into the room.
He took one look at the man and did a double-take. The EHR data record open on the computer and the hospital ID band on his wrist read Jesse Gutierrez. No way. The man on the stretcher was an old friend, Longorio Cabreja.
They’d met at Fort Bragg. At 251 square miles and a population that ranges up to 50,000, it was the largest military installation in the world. Cabreja was a Delta Force commander when Fischer was assigned there, fresh out of medical school. They weren’t quite twins—both were about six feet tall, with neatly cropped hair and lean, athletic frames. Maybe brothers from another mother. Fischer was fair with blue eyes and sandy-colored hair. Cabreja, his parents from Mexico, had brown eyes and dark brown, nearly black, hair.
They’d bonded over ice-cold bottles of Pabst Blue Ribbon and stories at the local dive bar. It turned out that Cabreja had grown up about an hour from Mason—little more than a stone’s throw in central-west Texas, where goats and cattle far outnumbered people and the mesquite, live oaks and prickly pears coexisted with native grasses, at least in the years when there was enough rain to sustain something besides the scrub brush. After about six months, Cabreja shipped out for another tour in Afghanistan. That was a dozen years ago. Mason hadn’t heard from him since. He’d assumed his friend was still in the game, or dead. That was the life of Delta Force soldiers.
The EHR said that the man on the ER table worked in Physical Plant. If that was all there was to it, Mason thought, what a terrible waste of the singular skills of a pinnacle warrior. Cabreja was clearly in extremis. A cursory exam revealed significant lung congestion, particularly on the left side, and crepitus, a grating sound consistent with rib fractures. He glanced again at the huge monitor hanging above the bed. The chest X-ray and CT scan were normal. No fluid, no fractures. That couldn’t be right. Vital seconds ticked by.
“This guy’s problem isn’t cardiac,” Mason said. “This looks like a severe deceleration injury. Rib fractures, fluid…probably blood in his left lung. He may have a torn aorta. He needs to be in the trauma OR, not here!”
The attending physician was confused. “The chest X-ray and CT were normal.”
“Those imaging studies have to be from another patient.” Mason grabbed the other doctor’s hand and pressed down on the broken ribs.
“Get the trauma team here,” yelled the emergency medicine doctor. “Use the overhead. Where the hell are they?”
“Three minutes,” was the response.
Mason looked back at the man. Was it really Cabreja? His friend had identifying marks. Not unique, but close to it in combination. Mason saw all three: the faintest outline where the tattoo had been, a coiled rattler ready to strike that had been lasered off, per Delta protocol to prevent enemy identification; a jagged appendectomy scar from a surgery done by a Delta medic in the mountains of Afghanistan; and a long scar along his left upper arm, a sign of his trade. It’s him, Mason thought.
Then he heard a loud beep. Cabreja’s blood pressure dropped again.
“Hang two more units,” Mason instructed. “He’s bleeding out.”
Cabreja’s eyes snapped open. He was awake and confused. A breathing tube connected to a ventilator precluded clear speech. Still, he tried.
Mason looked at him intently. Even in his critical condition, Cabreja’s eyes smiled. Mason smiled as well as he grasped his shoulder.
“You’re hurt bad, man. Broken ribs, bleeding….”
Cabreja waved him off and tried to quickly speak—which was impossible with the endotracheal tube. When Mason shook his head, Cabreja slowly mouthed several words. It was clear Mason didn’t understand what he was trying to say, but before Cabreja could continue, the monitors blared again. Mason looked up. The heart rhythm was unchanged, but the blood pressure had dropped again.
Cabreja was fading fast. He had to get the message to Mason. He tightened his jaw and slowly mouthed short syllables.
“Guv op….” Guiterrez then mouthed the last two words of his life while holding up a single finger. “our north.”
“Government operation an hour north?” asked Mason. Cabreja gave a short nod, and then was out.
“Flatline. Defibrillate!” shouted the ER attending. “All clear.”
Mason stepped back. The defibrillator fired. Cabreja’s body jolted. The monitor was unchanged.
The trauma team arrived in force. “OR One is open,” said the lead surgeon, “but I’m going to have to open him here.” If Cabreja had any luck this day, it was that Drexel was one of the few hospitals that had a highly specialized critical care facility within the emergency room. Critical Care Room One was as fully equipped as any ICU room, anywhere. It could even be used as an operating room.
In less than a minute, Cabreja’s chest cavity was visible. The surgeon recognized an enlarged and misshapen aorta, indicating that the accident had caused a tear between the layers of the aorta. The injury led to nearly 100 percent mortality within hours.
“He’s got a big dissection. Jesus Christ, how did that get missed? And how did he hang on so long? He’s dumped ten units of blood in his chest.”
It was too little, too late. Half an hour later, they called it.
“Time of death is 8:38 AM.”
Jesse Gutierrez, or Longorio Cabreja, was dead.
Marschall S. Runge, M.D., Ph.D., is the executive vice president for Medical Affairs at the University of Michigan, dean of the Medical School, and CEO of Michigan Medicine. He earned his doctorate in molecular biology at Vanderbilt University and his medical degree from Johns Hopkins School of Medicine, where he also completed a residency in internal medicine. He was a cardiology fellow and faculty member at Massachusetts General Hospital. He is the author of over 250 publications and holds five patents for novel approaches to health care. As a Texas native who spent fifteen years in North Carolina, and an avid thriller reader, Runge has experienced so many you-can’t-make-this-up events that his transition to fiction was inevitable.
