“But how?” was all the med student could muster. He pulled his pen from his pocket and prepared to write. Villanueva abruptly grabbed the pen and the clipboard, and even loosened the student’s tie for good measure before stopping and facing him.
“Don’t write. Listen and learn from the master,” he said. He winked at an attractive nurse standing at the station. “I knew she needed more oxygen because her skin was pale and her lips were blue, that’s an easy one.” He was in full professor mode now, standing tall and upright, using his entire six-foot-two frame to project across the emergency room. As intimidated as all the students were by him, he was the reason the best of them from all over the country chose to come to Chelsea General. In the world of medicine, it is tough to call anyone the “best” at anything, but that wasn’t the case here. Villanueva was the most celebrated trauma chief in the country, hands down.
“Always remember to look at the Foley catheter bag,” he instructed the medical student. “These patients should be making plenty of urine. If they aren’t, it means they need more fluid.” The med student looked for something to write with before remembering Villanueva had his pen and clipboard. “Don’t worry about writing this stuff down,” Villanueva said again, reading the student’s mind. “Just immerse yourself in this situation and you will never forget.” The med student nodded like a true believer.
“By the way, how old is this woman?” Villanueva asked. The med student scurried over to Trauma Bay 8, checked the chart, and returned.
“Twenty-six,” he said. Squint. “No wait, her birthday’s in December. She’s twenty-five.” Villanueva smiled to himself.
“Now, I bet you’re wondering how I knew this little lady had a bomb explode in her brain,” Villanueva called for all to hear, enjoying his moment center stage. Truth was, a lot of people who pretended to be disinterested in the bombastic Villanueva were craning their necks trying to garner a little of his amassed wisdom.
He quickly grabbed a penlight from the student’s jacket. Villanueva himself never carried anything—no stethoscope, no tongue depressors, nothing to write with, certainly no penlight. He just grabbed what he needed from the closest victim. The penlight was simple white with no pharmaceutical advertising on the outside. Everyone knew how Villanueva felt about freebies from Pharma companies. “No such thing as a free lunch,” he had once shouted across the ER at an attractive woman drug representative as she scurried out of the ER. A single bright light emerged when he pushed the button, and he pointed it at the woman’s eyes.
“This young lady has a ruptured cerebral aneurysm. See here, a little disconjugate gaze,” he said.
“Disconju—what?” the med student replied.
“It means her eyes aren’t quite lined up.” Another squint. “Jesus, what are they teaching you these days? You think between the sensitivity training and the financial investment classes, they could teach you some medicine.” The med student blushed. “Oh, and her pupil on the right is larger than the one on the left. It means the aneurysm was pushing on one of the nerves in her brain that controls eye movements.”
“Oh, I get it.” A light went off in the med student’s brain. “The aneurysm ruptured while she was driving. Rendered her unconscious. That’s why she crashed her car…” He trailed off.
“Yes!” Villanueva shouted. “Like I said, she had a bomb go off in her head. Speaking of which, did anyone page Neurosurgery?”
“Yes, Dr. Villanueva,” an unseen female voice answered from across the room.
“Well, where the hell are they?”
“On his way,” the same faceless voice said.
“Which one of those overpaid and underutilized guys is it this time?” Villanueva asked.
“Dr. Wilson.”
Squint.
“Oh boy! I am surprised all you nurses haven’t already run to the powder room to doll up your hair and put on some lipstick,” Villanueva bellowed. “Oh, Dr. Wilson, can I help you, anything at all…really, Dr. Wilson…anything at all.” He had an alarmingly good falsetto.
The nurses giggled and shook their heads.
“Hey,” Villanueva said to the medical student. “Since I taught you all that, why don’t you go and get me a sandwich?” The student looked around, trying to figure out if Villanueva was joking or not. To no one in particular, the doctor called out, “And will someone please page pretty boy Wilson again?”
I
n a darkened call room, Ty Wilson sat, eyes closed, motionless and very still. There was a window cracked, and the smell of freshly fallen leaves wafted through the air. In the distance, the ripple of the Huron River could be heard. Other than that, the room was absolutely silent. His scrubs were a deep shade of blue, seemingly designed to match Wilson’s eyes. They also fit him perfectly, with no extra folds or wrinkles. He was on his knees, with his back straight as a dead man’s EKG. The neurosurgeon visualized his breath as he inhaled. In through the nose and then around the sinuses. First the maxillary and then the ethmoid sinuses, followed by the frontal sinuses. He visualized the breath going down the trachea, anterior to the esophagus. “About fourteen millimeters anterior to the esophagus,” Wilson had told his therapist.
“I don’t think you necessarily need to go into that level of detail,” the therapist had replied. “Actually…I do,” Wilson said.
Now he visualized the breath making its way into the progressively smaller bronchioles and then slowly getting absorbed into the bloodstream. It was his form of relaxation. Meditation didn’t really fit with his image of being a neurosurgeon, which was why Wilson mainly practiced it in the solitude of the call room. His beeper went off again.
Gato needs you. Now
.
Wilson opened his eyes, stood and walked out of the room. A minute later, when he pushed through the ER’s swinging doors, he looked every bit like a USC quarterback in to run the two-minute drill and win the game. He was tall and fit, with wavy dark hair and those blue eyes, which had a hypnotic effect on nurses, patients, just about anyone locked in his gaze. Villanueva, as it turned out, was an exception.
“Trauma Bay Eight,” Villanueva called to him. Villanueva glanced down at his beeper, which had just gone off. It said simply,
311. 6.
The medical student had returned with his sandwich and was peering over Villanueva’s shoulder at his beeper.
“What do all those numbers mean?”
Villanueva quickly crammed his pager back on his scrub pant waistband.
“What are you, a spy or something?” Villanueva took the sandwich and started eating, garbling a thank-you through his full mouth.
“No, just trying to learn,” the med student answered. “From the master,” he added, laughing.
Villanueva cackled. “Good, kid, I like that.” He thought about it for a second. “Those numbers represent an invitation to the most secret and best-guarded meetings that ever take place in a hospital,” he whispered. “Every few weeks, a select group of surgeons get together and discuss mistakes.”
The student’s eyes widened. “What kind of mistakes?”
“All kind of mistakes. Morbidity and Mortality, some call it. Others call it Death and Complications. I call it the Someone Effed Up Conference. Capiche?”
“Can I come?” the student asked.
“You one hundred percent, absolutely, without a doubt can
not
come,” replied Villanueva. “Did you not hear me when I said this was a secret meeting? Strictly invitation-only. No other doctors, no administrators, and certainly no friggin’ lawyers! This conference is for us, and us only.”
I
n the trauma bay, Wilson assessed the situation in just a few seconds. As he started to examine the young woman, he agreed with everything Villanueva had said. It was a classic case of chicken-and-egg in the world of neurosurgery. Doctors at many hospitals around the country would have heard the woman’s story and deduced in a matter of moments that the blood in her brain was a result of the car accident. They would also deduce that since she’d been in a single-car crash into a telephone pole, she was trying to kill herself. The truth was far different. The aneurysm, a small blister on the surface of an artery, had suddenly let loose, spraying blood throughout her brain. She had likely felt a sudden thunderclap headache, and within seconds was rendered unconscious. That was why she’d crashed her car. In this case, the aneurysm was the chicken. The car accident was the egg. The science of deduction, and Ty knew there was no one better at it than Villanueva.
Ty’s beeper went off again. Like Villanueva’s, it read
311. 6.
He took the message like a punch, sucking in air involuntarily. Tomorrow morning, he was going to be where no doctor at Chelsea General wanted to be. Ty forced himself to breathe out slowly, then caught Villanueva’s eye across the room. He wanted to see if the trauma chief had gotten the page. One glance at Villanueva’s expression of near pity, and Ty knew he had.
Damn
, Ty thought. The last thing he wanted was the fat man feeling sorry for him.
Villanueva muttered to himself, “Poor bastard.”
I
n the neurosurgery offices up on the twelfth floor of the hospital, a single light still shone along the long hallway, leaving the beautifully framed pictures of neurosurgeons present and past adorning the walls in subtle darkness. The names were all giants in the world of surgery: Edgar Kahn, Richard Schneider, Lazar Greenfield, Bob Bartlett, and Julian T. Hoff, who was widely credited with building Chelsea General into the powerful institution it now was. His nickname
BUZZ
was engraved under his name. The last picture was of Harding L. Hooten, the current chairman of surgery. Underneath the beautifully engraved wording of his name was his simple nickname:
THE BOSS
. There were also several museum-worthy paintings Hooten had requested through old-boy connections in the art world, also in shadows at the late hour.
Right outside his office was one of his favorites, Mark Rothko’s
Untitled 1964
, which was on loan from the National Gallery of Art. The abstract painting consisted of a large black rectangle with a dark gray rectangle inside. No one knew why the Boss liked it so much, but no one dared ask. There was a large Cy Twombly abstract and a David Hockney photo collage, also on loan, and a couple of John James Audubon prints Hooten brought from home. One showed a yellow-crowned heron, the other, a South American scarlet ibis. This particular ibis was one of the few birds Hooten had never seen with his own eyes, and he had spent a lot of his life hunting for the bird around the world. Most people who saw the art either had no idea of the works’ gilded provenance or assumed they were reproductions. The air smelled of the expensive cologne that seemed to linger around Hooten’s office.
Amid the grit of Chelsea General, Neurosurgery was far from the norm. Many other departments were so strapped for decorations that doctors would frame their children’s artwork and hang that up, or order the type of forgettable prints of generic landscapes or flowers more at home in discount hotels—anything to distract. Neurosurgery was so atypical that several faculty members were embarrassed by the appearance and often took pains to see their patients in other areas, instead of the museum-like atmosphere of their own department. Few things killed rapport with patients more than the impression that the doctor was getting rich treating them.
Inside one of the more modest offices near the end of the mostly dark hall, Dr. Tina Ridgeway sat next to a tired-looking junior resident holding a bag of microwave popcorn, a whiff of melted butter in the air. There were a few framed pictures on the bookcase in the corner. One was of a couple of young girls in cheerleader uniforms. Another was a wedding picture of a very pretty Tina and her new husband. There was a picture of the whole family crouched around a young girl in a wheelchair. Everyone was smiling, almost laughing in the picture, including the girl in the middle. They sat on a couch across from Tina’s desk, peering at Michelle’s book of neuroanatomy lying on the coffee table. The picture showed the two lobes of the cerebellum, and all the various blood vessels that supplied blood to the back of the brain. There were a lot of nonsense scribbles on the page, in typical doctor’s bad handwriting.
“C’mon Michelle, I’m not leaving till I’m sure you understand this,” Tina said. While Michelle slouched on the couch with a few kernels of popcorn sitting in her lap, Tina sat up straight. She looked crisp and in command. “Tell me again, what are the different types of posterior fossa tumors in children, and how you would manage each one?”
Michelle nervously adjusted her glasses. “Uh…medullo…uh, something like that.” She stammered something incomprehensible. Then she just sat, dejected and embarrassed.
Tina offered the younger woman some more popcorn as though that might fuel a burst of understanding. Michelle Robidaux was a resident pretty much everyone in the department had given up trying to help. She’d failed the boards twice, and all the faculty members were waiting for her to either quit or be fired. They ignored her during teaching rounds and hardly called her name when they needed a resident to scrub in on a case. They even asked senior residents to take extra call so Michelle was never allowed on call by herself. That served to alienate her even further from her colleagues. What they hadn’t counted on was Dr. Ridgeway’s unfaltering support for the young woman. The neurosurgeon had convinced all of her colleagues to give Michelle one more chance and allow Tina herself to mentor her. Some of her colleagues were sure Tina felt sorry for Michelle more than anything else. After all, Tina had grown up with everything, and Michelle, by all accounts, had been brought up on the wrong side of the tracks. This type of extra help was unheard of, considering Tina’s packed schedule as well as her husband and three children at home. Still, here Tina was teaching long after her family ate dinner, again, without her.
The contrast between the two women was striking. Aside from the fifteen-year gap that separated them, Dr. Tina Ridgeway was gorgeous in a way that went beyond her flawless skin, high cheekbones, and the kind of lips lots of women were paying lots of money to replicate. She carried herself in a way that somehow suggested elegance and grace, unheard-of commodities in an urban hospital like Chelsea General. Even though Tina always wore her hair pinned back and was rarely found in anything but scrubs, male residents from all over the hospital could be found furtively walking the hallway in front of her office for no apparent reason. They called her Chelsea-Lina, given her resemblance to the famous movie actress. Anyone spotting Dr. Ridgeway outside the hospital might guess that she was in the fashion business, or maybe a politician or community leader. She was the kind of woman who seemed to attract attention without trying.