10:20 A.M.
COLUMBIA-PRESBYTERIAN HOSPITAL
168TH STREET
NEW YORK CITY
Dr. Hiroo Takayama was in the finishing stages of a six-hour cardiac operation, carefully sewing an almost invisible plastic ring to the mitral valve of someone’s heart.
A female voice came over the operating room speaker.
“Dr. Takayama,” the voice said. “The president of the United States is being flown to the hospital. He’s in critical condition. Are you close?”
“Yes,” said Takayama. “What happened?”
“A terrorist attack,” she said.
“How bad?” said Takayama, continuing to work.
“Assume an ISS of seventy-five,” said the woman, “and please prepare for emergency surgery.”
There was one other surgeon in the OR, along with two anesthesiologists and a half dozen nurses.
The procedure was being filmed. Takayama’s surgical techniques were studied by surgeons across the world, regardless of language or nationality.
Takayama finished the weaving of the area beneath the man’s mitral valve, then nodded at the other surgeon as he cut from the operating theater, disrobing as he moved. Beneath his purple surgical garments, Takayama wore a pair of worn jeans, a T-shirt, and running shoes. He was soon sprinting to the elevator. He took it two floors down and ran to his office. He opened a filing cabinet and removed a small steel suitcase, then ran.
Takayama took the elevator to the roof. There, he opened the steel case. Inside was a form-fitting protective cushion. There were three things inside, nesting in the foam. One was a tall vial filled with a hazy yellowish fluid. There was a syringe. There was a black rectangular box, made of lead.
The vial contained pure adrenaline which Takayama had purchased himself from a cattle farm in Matsuzaka, Japan, extracted from the adrenal glands of bulls. Takayama worked routinely with synthetic adrenaline but the manufactured version, epinephrine, was different from the real thing.
He threaded the syringe and opened the tiny cork on the top of the vial, filling the syringe so that it was ready to be injected. He replaced the cork in the vial and set both vial and syringe back into the steel case next to the lead box, shut it, then stood next to the helipad, waiting.
For the first time, Takayama looked at the sky in the distance. His mouth opened, though he was speechless. A pair of nurses appeared and came to Takayama’s side, followed by a team rolling a bed.
Takayama pointed at a man near the door.
“Please get a second team up here immediately,” said Takayama. “Also, page Dr. Argenziano and Dr. Lee. Make sure the theater OR is ready.”