“Very good,
signore
.”
“
Buona sera
,” Pat said. Her accent was better than Sung’s. The waiter raised his eyebrows, jutted his lower lip, and nodded to show just how impressed he was.
“
Multi bene. E Italiana?
” he asked.
“Am I Italian?” Pat asked, giggling.
“
Si
.”
Pat laughed harder. At the sight of his wife, hand over her mouth, almost doubled over in laughter, Sung couldn’t help himself. He began laughing at the ridiculousness of it all.
The waiter asked if they wanted something from the bar. As soon as Pat composed herself enough to speak, she began laughing again until tears gathered at the corners of her eyes. Again, Park laughed along with her. He couldn’t think of the last time they had laughed like this.
M
onday Morning. Room 311. Sydney Saxena stood at the front of the room of Chelsea’s surgeons, a collection of some of the finest orthopods, chest cutters, vascular specialists, skull crackers, and others who donned scrubs and used well-intentioned violence to treat people for any number of deadly or chronic problems. These were men and women able to combine the physical talents of cutting, sewing, excising, replacing, repairing, attaching, reattaching, and thousands of other tasks big and small with the three-dimensional geometry of the body—the bones, muscles, ligaments, tendons, veins, arteries, nerves, lymph nodes, organs. They were able to match what they saw in the moment of surgery with their theoretical knowledge of what they should see given the diagnosis and patient history and what they’d seen before. And then they could adjust their plan accordingly. In the operating room, sports analogies are common, but quarterbacks calling an audible to counter a shifting defense or running from the pocket to avoid a blitzing cornerback had nothing on the brain surgeon scrambling to repair a ruptured aneurysm or the heart surgeon whose patient’s vitals were failing.
Sydney Saxena was not standing in the front of Chelsea’s surgeons to tell them how to do their jobs, or even to highlight an error in judgment or in execution. This morning was not the public flogging of the usual Monday Morning. It wasn’t the Somebody Effed Up Conference Villanueva liked to call it.
“Thanks for coming, everyone,” Sydney said. Hooten sat in his usual spot at the front of the room. Tina and Ty sat next to each other a couple of rows back. Villanueva sat on the aisle seat looking tired.
“I’m here this morning to talk about
Trypanosoma cruzi.
”
“Sydney, this is surgical M and M, not infectious diseases,” came a call from the back of the room. “You sure you’re in the right place?”
“I appreciate your concern,” Sydney said with a wry smile. “But I am in the right place, and so are all of you.
“I implanted a pacemaker this past week on a Mr. R, who had severe cardiomyopathy as the result of
Trypanosoma cruzi
, which many of you no doubt know as Chagas disease.”
With no doctor standing up front for a public flogging, the mood of the M&M was decidedly lighter than normal.
“Sydney, were you moonlighting in San Juan General?” orthopedic surgeon Stanley Gottlieb called from the back of the room.
Sydney smiled.
“Thank you, Stanley, you’ve just given me the segue I need. You see, I’ve been talking to the various departments here at Chelsea General. It seems that we are beginning to see diseases once reserved for the Third World and for tropical climates. It appears America’s poor and America’s immigrants are both more mobile and more vulnerable than we’ve seen—at least in our professional lifetimes.
“Let me give you an idea of some of the cases that have walked through our doors right here at Chelsea General.” Sydney looked down at some typed notes. “Helminth infections, toxocariasis, cysticercosis, cytomegalovirus, toxoplasmosis, leishmaniasis, and, last but not least, leptospirosis. Untreated, these are chronic and debilitating. Most of them will not require surgical intervention, but we need to be mindful that these cases are in the realm of the possible—even in the United States, even in Michigan.”
Ty tried to listen but he was distracted not only by the demons of Quinn McDaniel but by the now awkward feeling of sitting so close to Tina Ridgeway. Tina, too, seemed to be having trouble focusing.
“I almost forgot,” Sydney added. “At Henry Ford, they had a case of Weil’s disease. That is a hemorrhagic complication from a bacterial infection transmitted by rat urine. Are there any questions?”
Sydney looked around the room. She checked her watch.
“I’ve left you time for breakfast.” A collective groan went up. “
Bon appétit
.”
T
ina entered the maelstrom of orderlies pushing patients from their rooms to X-ray or the ER. There were doctors coming and going, and nurses beginning or ending their shifts, laughing and sharing stories. She saw relatives heading to the gift shop or the pharmacy or to see loved ones. It was the daily swirl that amid the chaos was somehow still a remarkable testament to order.
Tina had always believed the modern teaching hospital represented the pinnacle of learning and culture, knowledge acquired generation by generation until medical doctors were able to defeat diseases such as smallpox and polio and treat deadly scourges like HIV and cancer. When her father was at Mass General at her age, there was no less compassion and doctors were no less smart, but the cumulative knowledge was primitive compared with that of Tina and her colleagues, just as his generation was light-years ahead of her grandfather’s practice in rural Fairbury, Vermont. Tina had always felt immense pride in Chelsea General as an institution, an entity that combined great understanding and compassion, and in her own small role as a teacher and healer.
On this morning, as Tina walked among the men and women who worked there, and the patients with their friends and relatives, the whole place seemed somehow tarnished. She noticed grime by the baseboard in the corridor from the parking garage. She saw dust on the framed landscape that had decorated the wall as long as she had worked there. An orderly wheeled a patient toward her, and Tina noticed a crust of dried mucus on the old man’s cheek that had not been cleaned.
The hospital that was always the source of such immense pride for her seemed like just another institution, filled with its own collective weaknesses, political motivations, profit incentives. Tina had not been naive. All institutions, even hospitals, were run by people, and the natural state of the individual was of selfishness. After her latest night with Ty, Tina knew this firsthand. But Chelsea General as an institution seemed to reflect a crassness Tina never thought she’d see in a teaching hospital. Only recently, it had been lobbying state legislatures not to grant a competing hospital a certificate of need to use gamma radiation treatment, even though lives would certainly be saved by it. Quite simply, Chelsea General didn’t want business going elsewhere. And then there was Michelle’s firing. To Tina, the resident’s summary dismissal represented a level of cold calculation she never thought she’d see.
Michelle had come to her office before she’d left for Louisiana to figure out what to do next. Tina had received instructions from the hospital attorney not to discuss the case in any way. He said he was sure the young woman had lawyered up and was now intending to sue the hospital for breach of contract.
“I just wanted to say thank you” was all Michelle could get out before she started crying, jagged, oxygen-sucking sobs. Tina closed the door to her office and hugged the young doctor, patting a shoulder as she might have consoled one of her daughters, feeling like a betrayer. There was nothing Tina could say to make it right. She wrote her home and cell numbers on a piece of hospital stationery and told Michelle to call her anytime and to use her as a reference. The hospital attorney had instructed Tina to cease all communication with the fired doctor, but she refused to comply. She would not abandon Michelle completely. Now Tina realized she had in fact abandoned Michelle when the young MD needed her most. She had meekly allowed the hospital to throw this struggling doctor under the bus. When she was a resident, Dr. Daniel Barrow had stepped in on her behalf, tossing the report critical of her performance. She had done nothing more than protest halfheartedly to save Michelle. She had not raised any sort of formal protest. She hadn’t written a letter to the CEO—or anyone else for that matter.
As a senior physician on the staff, she was a part of the hospital. The institution paid her checks and defined her professionally. How could she remain on the staff if she no longer believed in its principles? The experience left her feeling dirty. But how could she leave? She was the family’s sole breadwinner.
Worse still, Tina felt sullied by her latest tryst with Ty. She enjoyed their night together, not only for the pleasure she received, but for the obvious pleasure she was able to give him. She had sought it out, convincing herself she had every right to the companionship and sexual fulfillment she was not getting at home. Now, as she strode under the hospital’s artificial lights, she could see clearly that it was a mistake. It was faulty logic fueled by self-pity. She had let herself down.
V
illanueva was on his perch wiping the pizza sauce from his mouth when a bus arrived with a man whose ears had been cut off. He was bawling curses and threats. A blood-soaked bandage was wrapped around his head. He was held down with restraints.
“Let me go, you fuckers. I need to go put the ears back where they can hear the voices. You shouldn’t have brought them. The voices. They won’t be able to hear the voices.” One of the EMTs carried a small cooler. Villanueva figured the ears were in there.
Villanueva grabbed another piece of pizza from the box behind him and bit half of it with a single bite.
“Seven. Take him to seven,” he called out, his mouth still full of pizza. The ED was a magnet for drunks, manics, delusionals, all of them seemingly with bloody head wounds spouting nonsense and needing staples, anti-psychotics, and more. As a resident, Villanueva once had a drunk with a gash in his head threaten to kill him if he tried to stitch him up. Villanueva had the lidocaine ready, planning to numb the wound before stitching him up with thread, but after the threat he traded the sutures for a stapler and called over a couple of male nurses to hold the man. Villanueva closed the wound with three quick, if inelegant, staples as the drunk howled with pain. The patient left without another word.
This earless individual with the bloody gauze around his head was obviously suffering from some sort of mania, but beyond that Villanueva could not figure out what he was talking about. Take the ears back? If he didn’t want the ears back on his head, where exactly did he want them?
A med student approached warily. The EMTs said they didn’t know his name, but the person who called 911 from a gallery said it was a Mr. Malchus, a famous artist.
“Can I get your name, sir?”
“Fuck off. What’s
your
name so I can add you to my lawsuit?” Malchus could still hear, despite the loss of his outer ears and the gauze bandage wrapped around his head.
“The name is Villanueva.” The Big Cat had slid off his stool and now stood over the patient. “That’s V-I-L-L-A-N-U-E-V-A. You want to pick on someone, try me on for size.”
“Villanueva, get me out of here!” The man tugged at the restraints binding his wrists and ankles to the gurney.
One of the EMTs touched his nose, which took a sudden turn to the right. Dried blood was caked below his nostril.
“Fist?” Villanueva asked.
“Elbow.”
Villanueva gave him a consoling pat on the shoulder. “Why don’t you head over to X-ray?”
Smythe joined the group. “I recognize this man,” he said in his clipped British accent.
“You picked a strange time to come out of the closet,” Villanueva said.
“No—”
“One of your Oxford buddies?”
“No—”
“How about—”
“For Chrissakes, Villanueva, this man was the subject of grand rounds. An acquired savant. The toast of the art community for his remarkable renditions of ears.”
“I guess he took that a little too far…All right, Mr. Malchus, what’s it going to be?”
“Fuck off, fat man. You cannot hold me against my will.”
“Either we hold you or the county holds you in the lockup. You assaulted the EMT, and you are a risk to yourself and others.”
“You got that right.” He struggled again to get his arms and legs loose, but could not. He allowed his bloody head to fall back on the gurney, breathing hard.
An ashen-faced woman arrived at the trauma bay. She was about thirty, pretty and stylishly dressed.
“Is Mr. Malchus going to be all right?”
“He’ll be fine. Are you his daughter?”
“No, I rep—I represent Mr. Malchus’s work.”
“Well, you’re going to have to talk some sense into him if he wants his ears back.”
The mention of the ears caused the woman to shudder.
“He’s lucky, ears are mostly cartilage so they’re pretty resilient. Very slow metabolism. And they’re in a cold saline bath. Even better. Even a severed finger can last twelve hours. In Anchorage, Alaska, some guy’s girlfriend cut off his penis and flushed it down the toilet on a Saturday night. A municipal worker retrieved it Sunday morning, and the man was whole again that night. I was going to say
back in action
but I think that might have been an overstatement.”
The woman forced a smile. Her pallor was turning a very pale gray-green. It was a shade you were unlikely to find in any of the city’s finer art galleries.
Within an hour or two, Malchus’s story—like all good stories—was all over the hospital. It spread from person to person, moving from the ER in concentric waves like a virulent infection: “Did you hear about the artist obsessed with ears?”