This was one of the Americans traits that vexed him. There were many others. Americans were also always in a hurry. They ate fast, drove fast, rushed from one thing to the next. They flipped channels, read headlines or abstracts or executive summaries, and then moved on. Shouldn’t you truly understand something before continuing to the next thing? This morning he was offering the assembled doctors a gift, a sculpture of ideas on the nature of brain injury, but they wanted him to rush through it. No one here wanted to savor the breadth of understanding the medical profession had gleaned in an eyeblink of history. Park was flustered. As a result, he spoke faster, with choppier English, and his grammar started falling apart.
“We all know Phineas live, but he is changed man. His personality surly. He swears a lot. His reasoning skills, diminished. His doctor offer him one thousand dollars for a pocketful of pebbles he collect, and Phineas refuse.”
“Dr. Park,” Hooten injected in a quiet voice. “This discourse is best suited for another time. Would you mind if we present the case of Ruth Hostetler?”
Park sighed, irritated that his history lesson wasn’t hitting the mark. He explained the facts of the odd woman in the print dress. He told his colleagues how he had placed a stereotactic frame on the patient, secured with screws that were placed through her skin and into the skull. He’d then made a precisely fourteen-millimeter incision over the right top of her head and used a perforating drill to expose her brain. A thin probe was then snaked directly into her brain, having been measured perfectly the night before. A slight charge was given, and the deep tissue stimulation had eliminated the patient’s tremors but produced a strange side effect, an awakening of carnal desire in this deeply religious woman.
“Was this side effect, this carnal desire you describe, was it directed only at her husband or was it directed at others in the room? You, for example?” Villanueva asked to more guffaws.
“George may want her phone number,” a male voice called from the back of the room.
“Gentlemen,” Hooten said. “We are not in a locker room. We are in a time-honored forum established so that we may learn from our mistakes. So we can become better surgeons and make this a better hospital.”
“Ruth Hostetler is like a modern Phineas Gage,” Park said. “We learn a lot about the brain, but there are things that remain unknown to us at this time.”
“Would you perform this procedure differently next time?” Hooten asked.
“Because etiology of side effect is not known, I say no. I do the same way,” Park said. He thought about the question a little more. “Two choices for us: Do not do deep tissue stimulation. Try medicine to solve the problem. Or, do deep tissue stimulation and accept the fact we do not know everything that may happen. I do the same way.”
“Very well, Dr. Park,” Hooten said. “A cautionary tale,” he added to the room at large.
Joining the doctors in the queue shuffling out of the room, Ty turned to Tina. “Did you see the study that found there are two hundred thirty-seven reasons people have sex?”
“Missed it,” she said, laughing.
“There were the obvious ones: ‘I was drunk.’ ‘For pleasure.’ ‘To reproduce.’ There was also ‘to feel better about myself.’ ‘To be closer to God.’ ‘For revenge.’ ‘For power.’ Need to add number two thirty-eight. Deep brain stimulation.”
“If the word gets out, the procedure could challenge breast augs in popularity,” Tina mused.
“No doubt.”
The two reached the hallway outside Room 311. Tina turned right. Ty turned left.
“You’re not heading this way?”
“Got something to do,” Ty said.
E
very time a doctor checks a patient’s records, he or she leaves electronic fingerprints. The hospital software was written to prevent curious doctors checking out the blood alcohol level of the Wolverines wideout admitted to Chelsea General after a car accident or the rap star’s lab results. Administrators take these breaches seriously. Doctors who weren’t directly involved in a patient’s care were warned to stay away from that patient’s electronic record. Chelsea General went so far as to kick a senior resident out of the orthopedics program for his curiosity over whether the rap star was high on marijuana or cocaine. Both, it turned out.
Ty found a computer in one of the hospital’s backwaters, a room in Pediatrics. He didn’t think the hospital would raise an institutional eyebrow if he checked Quinn McDaniel’s records. The boy had been his patient, after all. Wasn’t it laudable to review the records of his most damning case as a neurosurgeon? The software and those who monitored it would have no idea Ty wasn’t interested in when Quinn’s oxygen sats went south or how many pints of blood the boy had received before Ty had pronounced him. Ty wrote down only one bit of information from the boy’s records: Allison McDaniel’s address and phone number.
Even though Ty had officially done nothing wrong, he looked around. It was as though he was checking to see if store security was watching after he stuffed the James Worthy shirt into his pants. Ty had been so angry after his brother died that he’d done quite a bit of shoplifting, almost daring someone to stop him. Once, he took a basketball out of a box at a sporting goods store, inflated it with a pump the store was selling, and wrote his name on it with a black Sharpie he had brought with him. He then dribbled it out of the store. He never got caught. Even then he had quick hands and nerves.
As he left the room, he almost bumped into Monique Tran, who was pushing an older Vietnamese woman in a wheelchair. Monique was the scrub nurse who had been working the night of Quinn McDaniel’s death. She had watched the life drain out of the boy. Ty looked at Monique as though he’d seen a ghost.
“Don’t look so happy to see me, Dr. Wilson,” Monique joked.
“Sorry,” Ty said. “My mind was somewhere else.” He forced a smile.
“I guess.”
Ty almost hadn’t recognized her in civilian clothes instead of the scrubs and faux-snakeskin clogs she wore in the OR.
“Hey, Dr. Wilson, this is my grandmother.”
Wilson had assumed the woman in the wheelchair was a patient and hadn’t looked closely. Now he noted the same elegant cheekbones as Monique Tran. The old woman was tiny, practically disappearing in the wheelchair. A lot of his patients barely squeezed into that sized chair.
“Nice to meet you,” Ty said. The older woman bowed her head slightly.
“Doesn’t speak much English. She’s here to get evaluated for a new hip. Didn’t want to come but she couldn’t sleep it hurt so badly. She’s old school. Thinks pain is weakness. Have you seen that T-shirt?
PAIN IS THE BODY’S WAY OF LETTING WEAKNESS OUT
? That’s her.”
“I guess I haven’t,” Ty replied. Besides the clothes, there was something different about Nurse Tran. And it wasn’t just the mile-a-minute chatter. In the OR, she was practically mute.
“Well, Dr. Wilson, time to get her inside. Can’t wait to hear what she has to say when we get a little Versed on board. Maybe get a little wisdom from the old country.” She laughed.
Ty leaned over and affectionately shook hands with the older woman in the wheelchair. “Who is doing her hip?” he asked.
“We were thinking about Dr. David Martin, I hear he is very good?” Monique said cautiously.
“Uh, sure. Look, I don’t normally do this, but I would recommend Dr. Tom Spinelli. I would have him do mine, if I ever needed one,” Ty offered.
Monique thanked Ty and winked at him as she pushed past. The old woman nodded again as they passed. Monique had been thinking a lot about family since she’d decided to keep her baby. Now all she had to do was convince the father it was a good idea and convince her family that getting knocked up by a white boy, one from the South, no less, was all for the best. And, heck—his Vietnamese was getting better. Surely that would impress her parents.
Monique didn’t mention it to Ty but she’d been named after the old woman she was wheeling through the hospital—sort of. Her grandmother’s real name was Binh, which meant “peace,” but the sisters at Ecole Saint-Paul in Saigon had given her the French name Monique. Through primary and secondary school Tran Binh spent much of her time as Monique, and she had grown to love her alter ego. The name reminded her of the ease of her childhood before the war had crept into their life like mold.
Monique’s grandmother had left Vietnam at thirty-five, pregnant with her fourth child—Monique’s aunt Anh—and the family was suddenly destitute after growing up amid privilege on a leafy street near Tan Son Nhut air base. Her father had been a well-connected businessman, and her husband, Tran Van Vuong, worked for him.
Binh almost never spoke of her old life. When Catholic Social Services sponsored the Trans, they had already endured six squalid and dangerous months in a tent city in Thailand. Days after arriving in the United States, she had gone to work at a box factory to help the family make ends meet. She’d left her children with an older Vietnamese woman who lived nearby or with Monique’s mother, who was just twelve years old at the time.
Monique’s mother had eventually married a fellow refugee, and they’d always stuck close to their own community. Monique sighed and pushed her grandmother into the pre-op area. She thought about telling her about the baby after the IV drip started. Her grandmother was the one person who would probably understand.
S
ydney Saxena woke with a start. A cold rain was lashing the windows of her town house, but it wasn’t the gusting wind or sheets of rain across the windows that jolted her upright, fully conscious, at four in the morning. It was a patient, Joanna Whitman, a large, fifty-two-year-old African American woman who worked for the city of Ann Arbor. The woman was not even Sydney’s patient. Sydney had heard her history on grand rounds, and the story irritated her like an itch. She kept scratching but found no relief.
Sydney did not like mysteries. She liked to know. She needed to know on an almost pathological level, and this patient’s story was like a cipher no one at Chelsea had decoded. Of course, on some level, Sydney also wanted to solve this mystery because she wanted to be
the
doctor to crack the case. Sydney knew nothing about Joanna Whitman. She didn’t know if she was a mother or grandmother. She didn’t even know what she looked like. For Sydney, this was a clinical puzzle, devoid of any emotion.
Joanna Whitman had arrived at the hospital three months earlier with a runny nose, a headache, and a persistent cough. She had returned days earlier from Aruba, where she had traveled with her husband, and wondered if the circulating air in the plane had blown someone’s flu bug her way. The junior resident who did the H&P suspected a viral infection, and told her it would likely resolve on its own. It didn’t, and the woman returned two weeks later with fevers that were worse at night, feeling slightly winded going up stairs, and still suffering from that cough. A different resident saw her this time and prescribed amoxicillin and also Bactrim, along with codeine for the cough. He gave her strict instructions to take the full course of antibiotics, telling her the infection could in fact worsen if she didn’t. “Yes, yes, I know. Antibiotic-resistant bacteria,” she said in between coughs. The doctor had nothing to worry about. Joanna Whitman did not appear to be the noncompliant type, nor did she seem like a hypochondriac. There was something almost regal about the woman. The resident who gave her the course of antibiotics told her to come back if she didn’t feel better.
Joanna Whitman did just that. She returned to Chelsea General a third time a month later and was diagnosed with bronchitis. She left with another handful of scripts. The cough continued.
During a fourth visit, the woman was sent to get a chest X-ray, which turned out to be normal. There was something unusual, however. Her blood oxygen sats were only 84 percent, and she complained of mild chest pain whenever she took a breath. The senior resident who saw her this time decided she had bronchitis with an asthma component. She was given more medicine and an inhaler. She was collecting diagnoses and medicines, but she was not getting better. She was getting worse.
Joanna Whitman then went away for couple of weeks; she had returned only the day before. It was her fifth visit in three months. This time, the large woman complained of shortness of breath and was admitted overnight. Her husband, a dark-skinned man in a shirt and tie, sat at her bedside holding her hand, an expression of deep worry on his face. The worry was well founded. The doctors who had seen her, including the freshly minted residents, the senior residents, and the attending physicians, were now reduced to making educated guesses at what might be wrong with the woman, or to giving her medicines and tests to rule out different possibilities. Her chart was getting bigger, and that was a sure sign doctors had no idea of the diagnosis. Joanna Whitman was looking sallow, sickly, forlorn. As the rounding doctors walked from Joanna Whitman’s bedside, one resident had quipped out of earshot that they needed to write
GOK
in her chart: God Only Knows.
Sydney had been thinking about her case off and on in the twenty hours since she had heard the story described by the senior resident on rounds. Sydney was a cardiothoracic surgeon, not a general medicine internist, and yet this case still bothered her. Something wasn’t quite right. The arsenal of medicines Joanna Whitman had received had done nothing, or at least that’s the way it looked.
This woman did not smoke, but she was heavy, and heavy was never good. Sydney thought it would take at least two of her to make one Joanna Whitman. The obesity did not seem to slow the patient down, though, even if she had complained of foot pain and swelling in the past.
Sydney had wondered if she was exposed to airborne irritants or toxic chemicals in her daily life. Studies had shown that waste dumps and other environmental hazards were located more often in minority and low-income communities. Joanna was a midlevel bureaucrat in the city’s planning department, though, and lived in a middle-class neighborhood not far from Sydney.