For years, Hooten had thought Buck Tierney might be right for the job. He was well connected, and that could only help the hospital as it competed for the big-dollar treatment centers. Also, Tierney’s ego was so big he didn’t seem to worry much about what others thought of him. But Hooten was rethinking his reasoning. He had seen in Sydney Saxena a tenacity and the kind of unyielding standards that could make her the perfect person. She was young, not even forty. Hooten had been almost fifty when he took the job, replacing the legendary Julian Hoff. But Saxena had the right mind-set. She was driven to do the right thing and demanded excellence from everyone around her. She would not stand for shoddy medicine. Put her in place now, and she could keep the Department of Surgery in line for years. Now all he had to do was figure out how to overcome the resistance of folks like the CEO, Morgan Smith, who was vocally supportive of Tierney, and others on the board. Hooten was not naive. He knew the fact that Saxena was both young and a woman might hurt her chances among some of the old guard. Still, he knew she was the right person for the job.
T
y walked through Chelsea General feeling as though he suffered from a sort of hangover. He hadn’t been drinking, but his synapses seemed to be producing the same sort of disjointed, unfocused thoughts. He was unable to concentrate on anything for more than a minute or two. This, from a surgeon who was accustomed to performing intricate operations lasting eight hours or more.
Weighing on Ty’s consciousness, first and foremost, was the death of Quinn McDaniel. Unless Ty was fully engaged on something else, the dead boy seemed to intrude on his thoughts hourly. Ty tried to make light of this, thinking of these thoughts as the boy’s ghost. It didn’t help. He could see Quinn looking up at him as he operated. He could see the trust in the boy’s eyes.
Then there was Quinn McDaniel’s mother. Ty’s meeting with her at the diner had been unfulfilling. He wasn’t sure what he wanted from the first meeting, but he itched to see her again. Ty reasoned that he needed to know why before he ventured down that path a second time. Wasn’t his presence
salt in the wound
for this grieving mother?
Finally, there was Tina Ridgeway. She was a friend and confidante. Her support in the previous weeks had kept him from becoming more unmoored than he already felt. And then there were the rendezvous. Their after-hours meetings offered the kind of distraction that banished Quinn McDaniel for the hours they shared.
Beneath her opalescent beauty, though, Ty sensed a longing not unlike his own. A desire to escape, at least for a little while. And this, too, was unsettling for Ty. She was a married woman, which held the potential for emotional carnage beyond the two of them. She had a husband and children.
As his brain seemed to shuttle between these topics, none of them resolved or even fully scrutinized, Ty wound clockwise up the concrete fire stairs toward his small office in Neurosurgery. He hardly ever took an elevator. His brain was so scattered, he had to stop to check what floor he was on. He was three floors short.
Ty continued up. He didn’t hear a fire door above closing and almost bumped into Tina coming down the stairs.
“Ty! Good morning,” she said.
“Tina?”
“Are you all right?” She stood a step above him, on the landing next to a fire door. Her voice held genuine concern.
“Just surprised. Didn’t expect to see you.”
“Are you avoiding me?”
“No. No. That’s not it at all,” Ty said. “Just thought I was the only one who took the stairs.”
“I only take them down,” Tina confessed.
They stood in silence for a moment. Ty saw something in Tina in that moment. A hard look behind the classic beauty.
“Ty, last night was my idea, and I thoroughly enjoyed it,” Tina said quietly. Her soft voice resonated in the stairwell.
“I did, too, but—”
Tina held up a hand.
“Let me finish. You don’t have to feel guilty about it. I’ve enjoyed our—” Tina paused. “I’ve enjoyed our, uh—special times together. But it’s not going to happen again.”
“You’re right. I was being selfish. You’re married. That’s bad karma.”
Tina waved off this line of thinking.
“I don’t worry about karma anymore. I used to. I used to think growing up privileged as I did, karma was stacked against me. I tiptoed through life, waiting for the karma to even out. Then Ashley was born. And I realized things are going to happen in our lives, and it’s egotistical to think we’re responsible.” Tina spoke as though the words were spilling out. “Daughters have cerebral palsy. Marriages go sour. But to think a divine being is up there with a scorecard.” Tina scoffed. “Bad things happen—”
“—to good people,” Ty finished.
“Yes. Right. Anyway,” Tina continued. “I’m not worrying about anyone’s expectations anymore. I’ve been living the life others have expected of me. That’s over. I’m going to live a life I can be proud of. I am going to be true to myself.”
Ty found the look of determination on Tina’s face slightly unsettling. She looked as though she had made some sort of major decision.
“Is there anything I can do?” Ty asked.
“You’ve done enough.” She leaned over and kissed him on the forehead. She turned to go and stopped.
“Ty, I know you’ve been…” Tina paused searching for the right word. “Deeply troubled by the boy who died on the table. You’ve got to forgive yourself and move on. This hospital needs your skills.”
P
ark stood at the bedside of Jordan Malchus, an arc of doctors around the bed. Park had ignored Hooten’s advice to take time off, although he was now working about four hours a day instead of the fourteen that had been typical prior to his operation. The pull of medicine remained too strong for him to simply do nothing, which was how he considered staying home. And the chance to present at grand rounds was too good to pass up. Park loved the thrill of medical mysteries, and this man’s case certainly qualified as one. Put simply, weak or not, Jordan Malchus’s case was too interesting to ignore.
As Park spoke to the group, the man in the bed ignored them, and doodled on a small pad of paper as though someone was timing him. Those standing closest to him could see small shapes emerging on the white paper, one after another: ears. Each one beautifully rendered, anatomically perfect, yet each somehow conveying a different feeling. Sydney Saxena and Bill McManus stood next to each other a little farther back. Sydney couldn’t make out what the shapes were. She figured the patient was nervous at being the center of attention and was scribbling random doodles on the pad.
“Mr. Malchus is a fifty-six-year-old with no prior relevant history who suffered a pair of aneurysms. The bleeds were clipped surgically. Subsequent angiogram was clear.”
Park couldn’t help but think for a moment about the ominous cloud on his own MRI and his dark prognosis, despite how well everything had gone so far. He took a deep breath and continued.
“From a neurosurgical perspective, Mr. Malchus is asymptomatic. From a psychological perspective, it is a different story.
“Prior to surgery, Mr. Malchus worked as a welder in a machine shop, fabricating large mufflers for buildings, cruise ships, and so on. I have talked to his wife, and she says he never expressed any interest whatsoever in art.”
“I thought they were a bunch of pansies,” Malchus interjected. Park ignored him.
“Mr. Malchus has emerged from surgery with a monomania for drawing. More specifically, Mr. Malchus draws ears. He has drawn them on the walls of his apartment. On canvas. He draws them now.”
“We need to hear the voices. We all need to listen,” the man said matter-of-factly, still not looking up. The assembled doctors edged forward. Those who hadn’t recognized the shapes before now smiled and nodded to one another.
“Mr. Malchus sleeps very little. There are times he forgets his meals.”
“You sound like my wife,” the patient added, now with an edge in his voice. A couple of the junior doctors smiled until they realized Malchus was not joking.
“Mr. Malchus’s wife has moved out,” Park added.
“Good riddance,” Malchus said.
“I add this personal fact because it reflects on—”
Without looking up, Malchus interrupted. “She doesn’t understand the voices.”
“The reason I include this in Mr. Malchus’s history is that his wife has suggested her husband be prescribed a neurotropic medicine to mediate these symptoms,” Park said. “I consulted with Dr. Johnson from Neurology, and he agreed.”
Park placed a hand on the bedrail to steady himself and paused to catch his breath. He tired so easily.
“Why isn’t he already taking something?” Sydney asked.
“Wouldn’t that end his neurosis?” asked another.
“As I said, I have consulted with Dr. Johnson, and Mr. Malchus was offered this treatment option. He has declined any medication,” Park said.
“We all need to listen to the voices,” Malchus said again. “Can’t you see? I need to help us hear them.”
“Those ears are beautiful,” McManus said, nodding toward the page now filled with ears. For the first time, Malchus looked up at the doctors who were gawking at him. He stared at McManus, their eyes meeting, his gaze unwavering. He looked at him with such a searing intensity that McManus involuntarily took half a step backward, as though he might get singed.
“Mr. Malchus is what is called an acquired savant. There are other cases in the literature. Men and women who had no interest in painting or poetry or music who suffered a traumatic brain injury that resulted in a new skill and singular focus,” Park said. He paused again. He was out of breath.
“Apparently the art world has taken notice. He has a one-man show,
Stroke of Genius
, at the Marks Gallery next week.”
“Isn’t that the place that had an exhibit of cow fetuses in formaldehyde?” a small, bald doctor asked.
“My brother’s an artist. He’d kill for a show at the Marks,” a resident said, almost to herself.
“That’s not our concern, is it?” Sydney asked. “Aren’t we supposed to be worried about the well-being of the patient?”
“Isn’t that part of Mr. Malchus’s well-being?” McManus asked. His challenge was friendly. He was smiling and looking at Sydney when he asked the question.
“You tell her, my friend,” Malchus growled. When Dr. Park asked him to come in for another MRI, overnight observation, the presentation of his case at grand rounds, Malchus had said that as long as they kept him supplied with writing materials, he didn’t mind. He had thanked Park for working with the voices to give him this gift.
“So it’s okay that he ignores his dietary needs?” Sydney asked McManus. “It’s okay to ignore his wife?”
“She needed to get her fat ass out of there. The bitch tried to take my art supplies until I ate something.”
Sydney glared at the patient for a moment and then turned back to McManus.
“This is what you would call healthy behavior?”
McManus shrugged. “Isn’t a one-man show at a gallery a sign of functioning in society?”
“And the rest doesn’t matter? Skipping meals? The anti-social behavior?” Sydney asked. Her voice sounded strident.
I sound like a shrew
, she thought, appreciating the irony of her taking a stand against a single-minded work ethic. Every time she crossed paths with McManus, she seemed to act in strange and uncontrollable ways. Sydney felt her face go flush—another recurring theme in her encounters with McManus.
“If anti-social behavior and a propensity to work through meals were symptoms requiring psychotropic drugs, half the doctors on staff would have scripts for Haldol,” McManus said with a wry grin. The physicians laughed.
“Well, Dr. McManus, I will mark you down in favor of improper and inadequate treatment of your patients,” Sydney said suddenly. McManus looked confused.
Inside, Sydney was kicking herself. How did she become such a bitch? She heard echoes of herself in third grade, trying to put down any classmate who dared infringe on her role as the smartest kid in the class by answering one of Mrs. Fitzpatrick’s brain teasers. Sydney guarded her role as star student zealously. Now she couldn’t help but hear the childish tone in her voice. This, with a man she found attractive. She was mortified.
McManus, too, was speechless. After a moment of silence, he turned back to Park.
“Sorry for the interruption, Dr. Park.”
Park, exhausted by the effort, finished as quickly as he could, and the doctors filed out of the room in the order they had come in, with Park leading the way, followed by the other attendings, chief residents, senior residents, junior residents, and med students. Sydney and McManus left the room and turned in opposite directions without another word between them.
Park’s wife was waiting when he reached his office, and she drove him home.
V
illanueva was seated on his stool. Veteran nurse Roxanne Blake stood next to him. The ER was as quiet as it ever got for a Friday night. Even the normally blaring television in the waiting area was off.
“Is it cold out?” Villanueva asked.
“Nope.”
“Big game on?”
“Not that I know of.”
“
American Idol
?”
“No.”
“What gives?”
“You got me, Dr. V.”
“Where’s the Magnet?”
“Off,” the nurse answered. The Magnet was a tiny female resident. She’d earned the nickname because she was a vomit magnet. Every night she worked, the whole character of the ER changed with the prevalent theme being vomit, and lots of it. Drunks. Influenza. Food poisoning. It didn’t matter.
“Too bad. She’s got a streak going,” Villanueva said. “Is Dr. Um-So working tonight? Torturing him is always good in a pinch.”
“No such luck. He’s off, too.”
Villanueva surveyed his silent domain. When it was this slow, Villanueva got antsy. He was sure there would be a bus crash, or a fire, or, more likely, multiple shootings. Not that the possibilities worried him. There was an unwritten rule in hospitals. If things were quiet, no one was to point it out, or risk somehow jinxing it. That was not a rule Villanueva cared for. He enjoyed the rush of multiple traumas bursting through the door of the Emergency Department. He liked it better when they were already a little busy, though. It was like when he was waiting tables in high school at a little Mexican place called Guadalajara. He was a much better waiter when he was busy. When the restaurant was slow, he lost his timing. He arrived at tables late or early. The ED was no different.