Lynda La Plante - Deadly Intent

Monterrey, Mexico, is not to be confused with Monterey, California.

This Monterrey is a border town whose main industry and source of employment is a massive tile factory. Monterrey is where Dr. Manuel Mendosa has his small surgical clinic. His father had also been a surgeon, attached to the American army in Vietnam. He always maintained that his finest work had been done during the war, as he was able to finesse his reconstructive surgical abilities on the burned and disfigured soldiers.

His only son, Manuel, followed in his footsteps and became a qualified plastic surgeon. He had, under his fathers watchful eye, opened a practice in Mexico City. After his fathers death, Manuel had become addicted to drugs and sunk into debt. Accused of malpractice, he had gone into hiding. Manuel had then been coerced into operating on a known felon, altering the man's features to enable him to escape imprisonment.

Now, known in the underworld for his prowess, he was forced into performing many similar surgical operations. He was paid highly for his skill and silence, but he was nevertheless trapped and in constant fear for his life, should he ever refuse a request.

When Manuel received a call from a Mr. Smith, he knew this was yet another operation requiring his skill as a surgeon. He knew too that his life would depend upon his silence.

Mr. Smith was not American but English, and his arrival at the clinic, although expected, was met with trepidation. The patient was so tall he had to stoop to enter the small reception room. He was well dressed in a creamcolored suit and a white T-shirt. He carried a thin leather briefcase.

If Manuel felt trepidation; so did his new client. Miles from anywhere in the border town, he had arranged the meeting on word of mouth, hearing that Manuel was a genius. He had not expected to confront one of the most handsome men he had ever seen.

. Manuel was slender with beautiful artistic hands, dark hair swept back from a high forehead, every feature of his face chiseled, teeth white and gleaming. His pale blue cotton shirt with its priest collar, almost like a surgeon's short gown, was obviously handmade. The color made his wide, clear eyes even bluer, like azure.He was sitting expectantly as Mr. Smith entered."Good morning," the Englishman said."You needed to see me?" Manuel said quietly, in fluent English."Yes. That is correct.""You were recommended?""Yes. By ..."The Englishman said two names that sent chills down Manuel's stiff spine. He knew who they weremen he could not refuse."I will pay you in dollars."Manuel nodded and watched as the big man sat uncomfortably on one of the hard chairs in the reception area. He had no receptionist and no nurses. Only one person assisted him in his operationsan elderly Mexican, Enrico, who had worked alongside his father."I will need to take some particulars and discuss exactly what is required.""Obviously."Manuel liked his deep resonant voice, the way he appeared respectful. And yet there was a domineering confidence about him."Firstly, may I ask your age?""Sixty."Manuel leaned forward and picked up a clipboard from the coffee table."Do you suffer from high blood pressure?""Slightly.""Have you had any recent operations?""No.""Do you have any heart problems?""No.""Do you have any allergies?" "No.""No allergic reactions to antibiotics?""None."Manuel used a slim silver pen to write on his clipboard."Have you any blood disorders?""No.""Do you have transport?""Yes.""Somewhere to recover after surgery?""Yes."Manuel replaced the board onto the coffee table."Now I need to discuss the exact surgical requirements and modifications you would like me to achieve."Mr. Smith had started to sweat in the overheated reception; it was eighty degrees outside and there was no air-conditioning in the room. Compared to Manuel, he felt overweight and clumsy."I need to look younger."Manuel nodded, watching as Mr. Smith removed from his pocket a large envelope. He took out a thin folded piece of paper."Let me start with the liposuction. I want you to remove the excess fat from my stomach, armpits, and chest area, and I want my buttocks lifted, so they are tighter and stronger. I'll leave it up to you whether implants are required."Manuel nodded. That part of the procedure was simple."I will also want my hands looked at, get rid of the age spots, get my fingerprints lasered."Manuel nodded and then leaned forward to pick up his clipboard again. He turned over the top page and started jotting down notes."How tall are you?" he asked."Six feet three and a half.""Your weight?""Nineteen and a half stone."Manuel tapped the silver pen against his perfect teeth as he calculated what the weight was in kilos. Mr. Smith watched him, struck again by his handsomeness. He wondered if he was homosexual. Manuel wore no wedding ring, no jewelry of any kind, not even a wristwatch, and he seemed to remain cool, not perspiring at all in the oppressive heat."You want me to continue?""Yes.""Right. I want a new face. Nose, cheek implants, maybe even a little chin enhancement, and I want the mole on my right cheek removed."Manuel looked up and stared hard as Mr. Smith concentrated on the notepaper. He could see there were some drawings on it. Mr. Smith was showing his age. His gray hair was worn in a thinning ponytail. He had a hooked nose. His face had slight jowls and was heavily lined, as if he had spent many years in the sun. His lips were thin and his teeth stained yellowish from smoking. His eyes were dark brown and lined at the corners with hooded lids. Yet he was still what one would describe as handsomeor had been at one time."May I see that?" Manuel asked, with his hand outstretched.Mr. Smith passed over the single sheet of paper. Manuel studied it for a considerable time. There were a number of drawings and indications of what plastic surgery was wanted."This is very extensive and invasive surgery, Mr. Smith.""I'm aware of that.""When do you want to begin?""After this meeting."Manuel continued making his own notes. It was just after ten o'clock in the morning."I also want it all done in one session.""That will be impossible. The liposuction alone will take considerable time and it will be painful, requiring a few days to settle before the bandages can be removed. You will also need to wear elastic surgical bandages to maintain the tightness of the skin.""Yes, I know." "So may I suggest we start with the less invasive surgery and then judge how soon you would be fit enough to begin everything else?""No. I want everything done as soon as possible. I've brought with me the required amount of Fentanyl in preference to any other anesthetic. Are you familiar with this type of"Manuel interrupted him. "I'm aware of the use of Fentanyl for emergency surgery and that it is now quite commonly used in many hospitals as a fast means of pain blockage. 1 know how quickly, unlike most anesthetics, it leaves the system. But it's a very potent opiate that can create respiratory depression if oversubscribed. It can be used as an intravenous anesthetic, but I've never employed it.""I will determine how much 1 need.""That is a great risk, Mr. Smith, and one I am not prepared to take. You will require a general anesthetic, but it is up to you if you wish to use the Fentanyl as a means of pain relief."Manuel put his silver pen back into the breast pocket of his shirt. He hoped his request for a general anesthetic would make his client change his mind. It didn't."Very well. If that's what you advise.""Have you eaten anything today?""No, not since midnight."Manuel leaned over to a pocket built into the side of the chair."I will need to call my assistant," he said.Mr. Smith noticed for the first time that Manuel was sitting in a wheelchair and it freaked him."Is that a wheelchair?"Manuel glanced toward him as he dialed. "One of my own designs very light and battery-controlled.""You're a cripple?"Manuel gave a strange half smile. "Does it worry you? I do not operate with my feet, but if it concerns you ...""What's the matter with you?"Manuel had dialed a number on his mobile phone, but he didn't connect the call."I was addicted to crack cocaine. My spine was injured in a fall.""Are you still an addict?""I will be for the rest of my life, but I am no longer a user. I've been clean for four years." He held the phone up. "Have you changed your mind?"Mr. Smith hesitated and then gave a curt shake of his head. "Make the call," he said.Manuel wished he had walked out, but his client was obviously satisfied, so he called Enrico to come to the surgery. In contrast to the reception room, the adjoining operating theater was cold. Mr. Smith felt every hair on his body tingle. He was instructed to use a small shower room to scrub his body clean with the disinfectant provided. Then Manuel introduced Enrico, who led Mr. Smith to the table. He had already prepared a row of needles and the vials of Fentanyl. He checked the client's heart rate and blood pressure, which he noted was high180 over 120. He prepared a vein catheter for Mr. Smiths right hand and found a vein easily, attaching it for the anesthetic to be given. An aspirator machine stood ready for the liposuction; large packs of gauze and two big bottles of Xylocaine and adrenaline, plus dark bottles of iodine were at hand. Different rubber tubes were ready to connect to the cannula tubes, to attach to the liposuction machine. Next, Enrico opened Mr. Smith's gown and, using a paintbrush, painted three quadrants, center of his stomach and to both sides.He checked that there was an oxygen mask ready and a resuscitation machine in full working order. He attached a small clip onto Mr. Smith's index finger, which led to a machine to enable them to read the heartbeat. All of this was completed in total silence.Enrico then went to assist Manuel to scrub up in a large sink. Manuel let him scrub both his hands with alcohol gel and wheel him to the trolley so he could open the paper-wrapped gloves."Do you wish to inject yourself?" Manuel asked his client. It took a while for Mr. Smith to measure the exact amount before clenching his left fist and then watching as Enrico adeptly found a strong vein and injected him. It was very fast; Mr. Smith just had time to lie back before he felt the warmth spreading throughout his body."You can get started." he said, his voice slurred.He eventually became used to the hideous sound of the suction pump working. The incisions for the cannula tubes pressed deeply and painfully into the fat. Enrico used his foot to keep the pump working as the fat drained into two big vats. It took three and a half hours. At one point Manuel was concerned: Mr. Smith's pulse rate was at ninety-eight. He used the oxygen mask and waited for the pulse to return to normal.Manuel worked quickly, inserting the tubes and pumping out the fatty tissue. For him, it was a tedious, long-drawn-out procedure. He sat making drawings for the facial work he was asked to complete. Twice during the liposuction Enrico gestured for Manuel to double-check their patient; he also needed his help to turn the big man over to take the fat from his buttocks. Manuel, for all his incapacity, was very strong in the upper part of his body, and together they had been able to move him.One of the most strenuous parts of the suction process was drawing on the tight elastic bandages to make sure the body parts, where the fat had been removed, were held in place. The gauze was wrapped around first, then the bandages, then an elastic corset eased over the belly and chest. In truth, the wrapping this time was perhaps too tight, but Mr. Smith was a very big man and Manuel reckoned he was so macho, he would be able to deal with the constrictions and the painful bruising he was going to feel. They had removed an astonishing two and half liters of body fat. The next process was to tighten his buttocks. A banana-shaped incision was to be made across each cheek. Manuel calculated that he would spend at least an hour and a half on each, due to the number of internal stitches required layer by layer. The first general anesthetic was administered.Whatever pain he felt, three hours later Mr. Smith sat up asking for water. He drank thirstily before resting back and closing his eyes. His entire body felt as if it had been run over by a ten-ton truck. The pain was making his head throb; it was excruciating and he could find no comfort, even lying on his side."How long do you need before you work on my face?" he asked hoarsely.Manuel leaned close to him, checking his pulse."I really cannot begin any more surgery. I suggest you rest for two days. Then we will be able to remove these bandages so you will be more comfortable.""I don't have that amount of time. I want it done today.""I have to refuse. Your blood pressure was very high and you will need to have a second general anesthetic. It will be impossible to operate using only Fentanyl.""You get another ten thousand dollars if you continue.""It is too much of a risk. The work will take at the very least three hours. I have to virtually lift your entire face off and""Just do it.""I advise you to rest at least for tonight and return tomorrow.""Do