The Surgeon: A Rizzoli & Isles Novel: With Bonus Content

its divine nature, but I do not agree. It is by looking at the building blocks themselves that you recognize its miraculous properties.
    The machine beeps, a signal that the analysis is complete, and a report rolls out of the printer. I tear off the sheet and study the results.
    With just a glance, I know many things about Mrs. Susan Carmichael, whom I have never met. Her hematocrit is low—only 28, when it should be 40. She is anemic, lacking a normal supply of red blood cells, which are the carriers of oxygen. It is the protein hemoglobin, packed within these disk-shaped cells, that makes our blood red, that pinkens the nailbeds and brings a pretty flush to a young girl’s cheeks. Mrs. Carmichael’s nailbeds are sallow, and if one peeled back her eyelid, the conjunctiva would appear only the palest shell-pink. Because she is anemic, her heart must work all the faster to pump diluted blood through her arteries, and so she pauses at every flight of stairs to catch her breath, to calm her racing pulse. I picture her stooping forward, her hand to her throat, her chest heaving like a bellows. Anyone passing her on the stairs can see she is not well.
    I can see it just by looking at this sheet of paper.
    There is more. On the roof of her mouth are flecks of red—petechiae, where blood has broken through capillaries and lodged in the mucous membrane. Perhaps she’s unaware of these pinpoint bleeds. Perhaps she has noticed them elsewhere on her body, beneath her fingernails, or on her shins. Perhaps she finds bruises she cannot account for, startling islands of blue on her arms or her thighs, and she thinks hard about when she might have injured herself. Was it a bump against the car door? The child clinging to her leg with sturdy fists? She seeks external reasons, when the real cause lurks in her bloodstream.
    Her platelet count is twenty thousand; it should be ten times higher. Without platelets, the tiny cells that help form clots, the slightest bump may leave a bruise.
    There is yet more to be learned from this flimsy sheet of paper.
    I look at her white blood cell differential, and I see the explanation for her woes. The machine has detected the presence of myeloblasts, primitive white blood cell precursors that do not belong in the bloodstream. Susan Carmichael has acute myeloblastic leukemia.
    I picture her life as it will play out in the months to come. I see her lying prone on a treatment table, her eyes closed in pain as the bone marrow needle penetrates her hip.
    I see her hair falling out in clumps, until she surrenders to the inevitable, and the electric shaver.
    I see mornings with her crouched over the toilet bowl, and long days of staring at the ceiling, her universe shrunken to the four walls of her bedroom.
    Blood is the giver of life, the magic fluid that sustains us. But Susan Carmichael’s blood has turned against her; it flows in her veins like poison.
    All these intimate details I know about her, without ever having met her.
    I transmit the STAT results by fax to her physician, place the lab report in the out basket for later delivery, and reach for the next specimen. Another patient, another tube of blood.
    The connection between blood and life has been known since the dawn of man. The ancients did not know that blood is made in the marrow, or that most of it is merely water, but they did appreciate its power in ritual and sacrifice. The Aztecs used bone perforators and agave needles to pierce their own skin and draw blood. They poked holes through their lips or tongue or the flesh of their chest, and the blood that resulted was their personal offering to the gods. Today such self-mutilation would be called sick and grotesque, the hallmark of insanity.
    I wonder what the Aztecs would think of
us.
    Here I sit, in my sterile surroundings, garbed in white, my hands gloved to protect them from an accidental splash. How far we have strayed from our essential natures. Just the sight of blood can make some men faint, and people scurry to hide such horrors from the public eye, hosing down sidewalks where blood has spilled, or covering children’s eyes when violence erupts on the television. Humans have lost touch with who, and what, they really are.
    Some of us, however, have not.
    We walk among the rest, normal in every respect; perhaps we are more normal than anyone else because we have not allowed ourselves to be wrapped and mummified in civilization’s sterile bandages. We see blood, and we do