Protocol called for observing the patient for twelve hours before his organs could be removed. Villanueva looked again at the man. From his new vantage point, closer and lower to the man, he could see the exit wound, hidden beneath his long, greasy hair just above his right temporal lobe. A large chunk of his skull had been shot away. He noticed something else: A swastika tattoo adorned his right shoulder.
“Get him out of here,” Villanueva said. His anger was returning in force.
The neurologist had arrived in the ER, Dr. Susan Nguyen, and she ambled up to the man.
“Dr. Villanueva, a moment with the patient, if I may.”
“He’s not a patient. He’s a piece of shit.” Villanueva stood his ground.
“George. I need to take a look,” she said more forcefully.
He moved fast, and was up in her face in a split second. She covered her face and head, worried she was going to get hit, and several people braced and gasped. He stopped himself, squinted hard at her, and then turned away. “No. He’s brain-dead, and I don’t need a friggin’ neurologist to tell me that.
“Just get him out of here and out of my sight,” he yelled for good measure. Then, to himself, he added, “Find a nice dark hole he can wait in until the transplant people can get to him, and he can maybe do some good.”
Villanueva watched as a pair of orderlies wheeled the man out of the ER into a hallway that led to the main hospital building. Dr. Nguyen was still standing in the ER. “You have no idea if he is a candidate for organ donation, Jorge! For crying out loud, we don’t even know if he really is brain-dead.”
But Villanueva was already walking back into the middle of the ER. When he turned back to Trauma Bay 8, it was clear the old woman had died, her skin already gray. Nurses gently removed the various tubes and monitors that had invaded her body. Villanueva took off his glasses and rubbed his eyes hard. He walked and stumbled back to his stool, looking back over his shoulder a few times at the elderly woman, now being transported to the morgue.
Sitting on the stool, staring into the distance, Villanueva was suddenly transported to the small town where he grew up. He could almost see the looks of fear, or disgust, or pure hate his family got sometimes as they ambled down the town’s main street. Just for being there. His father’s one luxury was to take the family to The Family Diner on Main Street after Mass on Sundays, when he wasn’t working. Even as a boy five or six years old, George could see the narrowed eyes, the looks of disapproval, as his mother and father walked with him and his two sisters from church. For what? Because their skin was darker than folks whose grandparents had grown up in Dexter, whose ancestors had traveled west from Germany or Denmark or England to settle in this small town in a state they, too, probably couldn’t pronounce when they arrived. Even fellow Catholics who turned to George’s family in church and shook their hands with a smile and a “peace be with you” seemed to have a change of attitude outside the dark, brick church with its dusty smell and muted light.
Villanueva’s own grandfather was a Mexican from the state of Durango. His father, George’s great-grandfather, had been a miner in El Palmito and died in his forties when he was kicked by a horse. George never met his grandfather. He dropped dead in his fifties, when George was just a baby, and Villanueva had no idea how he decided to settle in south eastern Michigan. He worked as a blacksmith in the few years that remained before repairing wagon wheels and shoeing horses became irrelevant. Then he worked as a laborer, finally landing a job as a janitor at the local high school.
At the diner, George would order the Big Breakfast Special, and his
Papi
would joke with the waitress about his son’s appetite. “Soon, the chickens will have to work overtime to keep up with this boy,” or “You sure you got enough food back there?” He would make these comments proudly. He was the provider, and his son was quickly becoming a big, strong kid.
When George was a teenager, and some freakish combination of genes and chance turned him into a hulking figure, things changed for the Villanuevas. Sports was a big deal in Dexter, and being a football star conferred status on the entire family. His father would be greeted by those who had previously ignored him: “How’s the team looking?” “How’s George feeling?” “Tell him to eat his Wheaties for Friday night’s game! I hear Pius is strong this year.”
George himself had transformed from the colossal kid of an immigrant slaughterhouse worker to someone the town, including the local police, wanted to look out for and take care of. When he and his football buddies would throw a post-game beer party that got out of control, a local cop named Pederson would arrive and tell them to keep it down and that they’d all be spending the night right there.
“Call your parents. I know everyone here is drunk. I’m going to be waiting just down the road. Anyone tries to leave is getting arrested.”
It didn’t hurt that Pederson was a big football fan and wanted to make sure George was always healthy for the upcoming games. Nowadays Villanueva spent a lot of time taking care of drunk teenagers who wrecked their own cars, but didn't have a Pederson looking out for them. Ultimately, George graduated from high school and made the town proud by starring at Michigan and then playing in the NFL. Even to this day, ESPN would show highlight clips from a few of his days in the big leagues. If one of those clips aired on the TV in the ER waiting room, nurses and doctors would gather around. They would cheer as George lumbered in front of the running back on a sweep or defended the quarterback from rushing defenders. Gato, never a stranger to attention, could often be found in the middle of the crowd gesticulating wildly and loudly narrating exactly what had happened during that particular game.
Still, the Big Cat never completely got over the slurs and slights he heard and felt as a child: When the white children didn’t invite him to their birthday parties or play with him on the playground. When they didn’t want to eat food he had touched or come over to his house.
There was one incident that burned into George’s memory. When he was six, the meatpacking plant held a special day for its workers. There were pony rides and carnival games. The company also sent its Hot Dog Hot Rod from the headquarters in Madison, Wisconsin. It was a bun-colored sports car decked out with a giant red hot dog above its Space Age cockpit. A driver in a special uniform was taking the children of plant workers for a spin around town. Young George waited for almost an hour for his turn. As he was about to get in the car, a boy in George’s grade named Steve ran up and tried to cut the line.
“I’m next,” George protested.
“He’s been waiting,” the driver said, shrugging.
“I didn’t know they let wetbacks in the Hot Dog Hot Rod,” Steve said.
George didn’t find out until later what a wetback was, but he knew he was being insulted and he knew it had something to do with his heritage. Worse than the comment itself was the driver’s reaction. He laughed and gave another shrug as though he couldn’t agree more, but what was he going to do. The ride was ruined for George, and his radar for ethnic slights was fine-tuned from that day on.
Seeing the white supremacist arrive in Chelsea General Emergency Department, his Emergency Department, was like someone pulling off the scab on those childhood insults and rejections. He was relieved to see the man wheeled away. Even in that moment, Villanueva was self-aware enough to realize that he had acted out of passion and not reason, and he hoped it wouldn’t come back to bite him on the ass.
S
ung Park’s wife, Pat, and his two daughters flanked the gurney as the anesthesiologist pushed Park down the hallway. The wheels squeaked on the freshly waxed linoleum. The IV bag of Lactated Ringer’s hanging from a pole swayed with the tall anesthesiologist’s steps. Park was the first elective surgery of the day.
Pat Park rested a hand on her husband’s left shoulder and said nothing. Each daughter held one of Park’s hands, which were pinned to his sides by the gurney’s railings. His five-year-old daughter Emily’s eyes were red from crying but she tried to put on a brave face, her lower lip quivering with the effort.
Park’s two-year-old son Peter was home with a neighbor’s teenage daughter, who would take him to a church preschool, happily unaware of his father’s tenuous condition.
Sedated but awake, Sung Park lay on his back in his hospital gown, looking up at the fluorescent lights. Under the effects of the anxiolytic Versed, Park wasn’t focused on the operation. He was thinking that the lights passing overhead looked like stripes on the highway. He also wondered if the hospital should consider painting the ceiling a more soothing color, as it was the only thing a patient, lying flat on his back, could see. Might make for an interesting controlled study, he thought to himself. He, too, said nothing.
Pushing the gurney, Dr. Reginald Culbreath broke the silence. Culbreath’s name was on the list of doctors Park had presented to Hooten the day before, along with the neurosurgical resident Aisha Ali, circulating nurse Melinda Brown, and scrub nurse LaTanya Scott. Culbreath was a tall, pear-shaped, African American doctor with a taste for jazz and bad jokes.
“All right, Sung,” he said. “Time to see how the other half lives.” He patted the shoulder not taken by Pat Park’s small hand. Park had never been admitted to the hospital, never broken a bone, never been to the emergency room. He had never even called in sick. He truly had no idea how the other half lived, and lying on the gurney was giving him a new perspective. Park himself hardly ever entered the operating room until the patient was already under general anesthesia. He wondered to himself if that might change, after this experience. Before he was sedated, he bridled at the sensation of not being in control, of relying on others. Now, flat on his back, high on the anti-anxiety med Versed, he didn’t care much one way or the other.
As Culbreath turned the final corner toward the OR, Park still said nothing. Park had done plenty of glioblastomas. He knew firsthand what a daunting surgical challenge he posed for Harding Hooten. For one thing, the extent of the malignant gliomas often extended beyond what showed up on MRIs. They were nasty invasive cancers whose rubbery tentacles often invaded the surrounding tissue. They were like the vine that overwhelmed the trees and fences along Northern highways, he thought. He made a mental note to remember this analogy the next time he spoke about glioblastomas, but he knew the sedative made it unlikely he would. At some other level, he knew he might never teach again. He knew this would devastate him, but in the narcotic cloud he didn’t care.
Lying awake in his bed at home a couple of hours earlier, Park had felt a spike of fear as he pondered his prognosis. As if the presence of a fast-moving cancer in his brain were not enough, malignant glioblastomas attacked a person’s very nature: potentially affecting personality, speech, learning, memory, cognitive ability. Park had briefly considered suicide as a logical response to his diagnosis. A glioblastoma was like a checkmate, Park had thought. You’re trapped. Nowhere to go. Game over. But Park was not a quitter. Resolve seemed to be part of his fabric, what he was made of, so he would fight this cancer.
Park knew the median survival rate for a tumor like his was 73.4 weeks. He hadn’t given his wife the statistics, but she had been married to a brain surgeon long enough to know that his diagnosis almost certainly meant their life together would be measured in months, maybe years, but not decades. He was grateful Pat handled the family finances already. There would not be much for her to learn when he was gone. He had reviewed the paperwork in a folder at the back of his filing cabinet. He remembered when he and his wife had sat down with a lawyer during the third trimester of Pat’s pregnancy. They had methodically filled out the papers creating a will. At one point, the lawyer had asked Park, “What do you want to happen if you are in a terminal condition?” Park had stared hard at the lawyer and said, “Sir, we are all in a terminal condition.” He thought he was being a tough guy who could stare death in the face and never blink. Truth was, he had been brave because he never imagined being in the scenario the lawyer had been trying to describe. He felt a tear well up, but didn’t want to take his hands away from his daughters. He casually turned his head and wiped the tear away with the pillow edge.
The gurney reached the end of the hallway. A large sign on the double doors read:
SURGICAL PERSONNEL ONLY BEYOND THIS POINT
. Culbreath turned to Park’s wife and children.
“End of the line. You’re going to have to stop here, Pat.” Most family members didn’t get to escort their loved one down the hallway between Pre-Op and the operating room, but Culbreath had called them back and let them walk with Sung to the OR.
“Thanks, Reggie,” Pat said.
Park’s wife bent over and kissed her husband on the forehead, then turned away from the gurney so her husband and children could not see her cry.
“We love you, Daddy,” Natalie, the younger of his daughters, called as the gurney went through the double doors where Harding Hooten was already scrubbing in, with his surgical loupes and headlamp clamped around his head.
Sung tipped his head back to answer, but he was already through the doors.
A
s Sung Park was heading into the operating room, Tina Ridgeway was standing in an examination room at The Free Clinic, a mile and a half away on a map but a world away in every other sense. Chelsea General stood as the town’s most venerable landmark, its original six-story brick building proudly facing the street and now ringed on three sides by an ever-expanding constellation of enormous additions and parking decks in styles and materials reflecting the tastes of their day. Altogether, the campus—as administrators liked to call it—covered more than six blocks and a hundred acres, and the buildings and decks were connected by a web of tunnels and elevated walkways. The Free Clinic, on the other hand, was a low, squat concrete building, a former print shop between a fast-food chicken restaurant and a discount store. Inside, the carpet was frayed, and makeshift exam rooms were stocked with volunteer doctors and donated supplies. She hadn’t told Hooten yet—heck, she hadn’t even told Ty—but she wanted to leave her job at the most preeminent medical institution in the country and use her skills here. Sure, she was a neurosurgeon, but she could provide many of the medical services so dramatically needed, yet woefully unavailable.