“I should have known!”
“Must be some sort of coincidence,” McManus said, barely suppressing a grin.
“Now I know what sort of pathology I’m dealing with here.”
McManus looked at his pager and saw the same unfamiliar number.
D
riving to clinic, Ty felt the elation of someone healthy after a long illness. He was energized. He couldn’t wait to see new patients. Pulling into the physicians’ parking area he spotted a nurse getting out of her car. It was Monique Tran. He was immediately transported back to Room 14 on October 23. She had been there on the day Quinn McDaniel died. He took in a deep breath, and waited for all the feelings to come flooding back. But nothing happened. Thinking of the boy did not cause a relapse of doubt.
Instead, Ty thought it strange Monique was parking there because nurses had their own parking three levels up in the garage. Then he saw a resident emerge from the car, Dr. Sanford Williams. The young doctor placed an arm around the shorter nurse. Ty now noticed the bulge in her pink scrub shirt. She was pregnant. It all clicked into place in his mind. Ty continued up the ramp to the next level. He thought about the awe and excitement that must come from bringing new life into the world. Right then, Ty’s pager went off. He looked at it, and pure panic crossed his face.
I
nside the hospital, Marjorie Gonsalves was lying in a bed for observation. Her husband brought her around midnight, confused and near collapse. She had seen her doctor the day before complaining of abdominal pain and was now reporting the addition of pain in her chest. Also, she said she felt dizzy when she stood up. The resident considered gastritis, aortitis, and cirrhosis of the liver. But none seemed a good fit.
The forty-year-old woman said she didn’t drink and used nonsteroidal anti-inflammatories only sparingly. Alcohol and prolonged use of NSAIDs were two common ways people could end up with inflammation in their stomach lining. Nor had she had surgery or a severe infection or an auto-immune disorder or chronic bile reflux, which were other possible causes of gastritis. The resident decided to hold off for the time being on an upper gastrointestinal endoscopy.
As for aortitis, an inflammation of the aorta, her chest pain and confusion when she arrived at Chelsea General certainly fit the bill of Phase III aortitis. Her history did not. She had not suffered from a trauma or infection. The woman had been happily married for twenty years and bristled when the medical student taking her history asked about gonorrhea, syphilis, or herpes. Nor did she have any history of TB or hepatitis. Also, the resident took the blood pressure on each arm. A difference would point to vascular obstruction. There was none.
Gonsalves had a lifelong history of allergies and asthma, but neither of these seemed to be a likely source of her troubles.
Stumped by the case and swamped by other admissions, the resident turned his attention elsewhere.
Marjorie Gonsalves’s temperature had been normal when she was admitted at midnight, but it began to spike. At eight the following morning, it was 101. By afternoon, it was over 103.
Worse still, Gonsalves’s list of symptoms began growing. The pain spread, and she began itching. Her eyes became puffy.
The resident finishing his shift thought it must be something to do with the patient’s allergies. The resident who arrived that evening, Dr. Eduardo Torres, decided to order a differential. When this blood test came back an hour later, it showed Gonsalves’s white blood cell count spiking along with her temperature, primarily because of eosinophils. These white blood cells, which stained orange-red, were possibly a sign of a viral infection. But what virus? Herpes and hepatitis had been ruled out.
Villanueva was leaving the cafeteria when Torres stopped him to see if he had any thoughts about what could be ailing Mrs. Gonsalves. Villanueva, for once, was stumped. He was experiencing some stomach pain himself and made a mental note to lighten up on the hot sauce with his grits. He told Torres to seek out Dr. Um-So.
“Guy’s a friggin’ encyclopedia,” Villanueva said.
When Um-So, aka Kauffman, arrived at Mrs. Gonsalves’s bedside, her voice was down to a barely audible croak. Outside her room, Torres explained why he had ruled out Cushing’s disease and a host of other possibilities. He asked if Kauffman had ever seen an allergic reaction present these types of symptoms. Um-So said nothing. He looked through the door at Gonsalves. She stared up at the ceiling, arms crossed on her chest like a corpse. Kauffman stared for a long time, then he approached the bed and knelt close to her ear.
“Um so, Mrs. Gonsalves, do you like to cook?” Kauffman asked. Torres looked at him as though he’d lost his mind.
“Yes,” Gonsalves croaked.
“You make linguica, chorizo?”
Here, Gonsalves offered an approximation of a smile. “Yes,” she said again.
“Thanks.”
Kauffman left the room. A bewildered Torres followed.
“Trichinosis,” Um-So said. “See the cut on her finger. My mother used to cut herself like that all the time cooking. Um so, she must have tasted the seasoning on the raw pork when she was cooking.” Worms from the raw meat had infected her body. Villanueva stood outside the room and smiled as Kauffman and Torres walked. He raised his eyebrows, as if to say
See, I told you he would figure it out
. Suddenly three shrills went off in rapid sequence. All three doctors reached for their pagers, and they all saw an unfamiliar number on the screen.
I
t was almost dark when Tina closed the front door of The Free Clinic and locked the deadbolt. She was alone. Usually, she and DeShawn walked out together, but he had left early because his twelve-year-old daughter was sick in bed with a fever. His wife worked a night shift at an Ann Arbor hotel as a front desk clerk, and the girl, Alisha, spent an hour alone most days between the time her mother left for work and her father got home. On this night, Tina insisted DeShawn be with his sick daughter.
Tina was putting the keys in her purse when the punch hit her left eye. She didn’t know it was a punch. She felt as though something inside her head exploded. She turned and saw a familiar-looking man wearing a green fatigue jacket. “Told you I would be back, bitch,” she heard. She blacked out before she hit the sidewalk. She didn’t feel the second blow or the third or any of the other punches and kicks that followed. She didn’t feel the baseball bat hitting her in the head or the chest or the abdomen.
M
ichelle had packed her bags and loaded her car to the ceiling with her belongings. Anything that didn’t fit—the ficus tree, the coatrack—she simply gave away. She planned to drive straight through, from Michigan to Louisiana. Mapquest said the trip would take eighteen and a half hours. She was hoping to cut some time off that. Still, she thought her resident training would come in handy. She was accustomed to staying up all night on caffeine and adrenaline. Caffeine was no problem. She had a large thermos of chicory coffee made for the trip. The adrenaline might be in short supply. She expected a long, boring drive through the night as she headed south toward Fort Wayne, Indiana, then west toward St. Louis before pointing the car south and passing through Missouri, Arkansas, Tennessee, Mississippi, and finally entering Louisiana. She prepared for the mind-numbing twelve-hundred-mile trip by lining up her favorite Cajun CDs on the visor on her old Civic. She planned to sing along at the top of her lungs as much as possible. Anything but think about what had happened at Chelsea General and what would happen in the weeks and months ahead.
Michelle had almost reached the on-ramp to I-94 when she was nagged by a piece of unfinished business and turned the car around.
Ten minutes later, she slowed outside The Free Clinic.
Too late
, she thought when she saw the lights out in the picture window. She was about to leave when she noticed the body lying in front of clinic. It looked as though a homeless person had simply passed out by the front door. Michelle was about to pull away when an alarm in her brain went off. Something about the picture wasn’t right, but she couldn’t immediately figure it out. She scanned again, and figured it was just somebody sleeping off a bender waiting for the clinic to open in the morning. Then her breath caught in her throat. High-heeled shoes. She recognized them. She had, in fact, coveted them from afar, for their elegance and the regal bearing of their wearer.
Michelle pulled over and stopped the car. She ran to the unmoving form without closing the driver’s door.
“Sweet Jesus,” Michelle said out loud.
If she hadn’t known who it was, Michelle would not have recognized her mentor, her lone supporter at Chelsea General when her residency hit the rocks. Tina’s face was battered beyond recognition. Her eyes were swollen shut. Her lips were cracked and bleeding. Her nose had been broken. That was simply what Michelle could see. She checked for vitals. Tina’s chest wasn’t rising, and Michelle could tell several ribs were broken. A check for a pulse revealed nothing. Michelle pulled out her cell phone and called 911, put it on speaker, and immediately started chest compressions.
T
he paramedics arrived in the Emergency Department with Michelle walking behind the gurney. The entire staff seemed to be waiting in the trauma bay. Some were crying, and there was an audible gasp as people caught their first glimpse of a lifeless Tina Ridgeway. Villanueva marched into the foreground. The sight of his friend and colleague hit him like a punch. He hesitated momentarily, then went to work. He removed the trauma blankets covering Tina and hollered “Seven!” The gurney was quickly rolled in. Sanford and Tran came running in, followed in hot pursuit by Ty. “Tina…is that really Tina?” Ty asked no one in particular. He began to weep. McManus and Saxena ran into the ER, still dressed from their romantic dinner. “What happened?” Saxena shouted. Soon, everyone was jockeying for position, with all of Chelsea’s finest working shoulder-to-shoulder trying to save one of their own. Hooten received a call at home and immediately returned to the hospital. He was the one to take Tina’s husband, Mark, and their daughters into a private room to tell them what happened. Mark’s sobs could be heard throughout the waiting room.
“The good news,” Hooten told them, “is Tina is alive.” Other than that, the news was grim. She had lost a lot of blood and had terrible injuries to her head. She had lost several of her teeth. Her jaw was broken. The orbit beneath one of her eyes was broken, as were several of her ribs. Her kidney was bruised. The worst news of all was that she had a severe brain injury. The trauma from the fall or possibly a kick in the head was causing her brain to swell. Villanueva and Ty had decided to induce a coma to slow the swelling and give poor Tina’s brain a chance to recover. Villanueva sedated her and placed her under a special blanket to begin cooling her body. Ty collected himself, prepped the operating room, and was standing by ready for action, but everyone recognized that this type of brain injury wouldn’t benefit from surgery. She could only heal on her own. It would be days before they’d know if Tina would survive and whether she had sustained any permanent brain damage in the attack.
M
aybe Harding Hooten should have taken a page out of Ty Wilson’s playbook and done some deep breathing and meditation before he headed into the OR, but the case was an emergency. Maybe he shouldn’t have scheduled the meeting in his office while he was covering the OR, but truth be told the get-together went far beyond its allotted time and the chance of a neurosurgical emergency requiring his presence was slim. Maybe he should have let a resident take the case. Maybe he should have checked the film one more time. Maybe he should have realized how much Tina’s case was affecting him. Or how much stress he felt by firing Michelle Robidaux.
Eaton Lake was a friend, or, more accurately, their wives were. The women served together on a number of boards: the zoo board, the opera, the Alzheimer’s association. Harding and Eaton had shared more than a few nights together at black-tie fund-raisers their wives had helped organize. Now Eaton wanted to make a real name for himself in Michigan’s philanthropic community, and he went to see Hooten first. This was a huge opportunity for the hospital. When the doctor heard how much wealth Eaton had accumulated handling mergers and acquisitions, he was stunned. Eaton said he had $150 million—“give or take”—to give to the hospital. Maybe the knowledge that this man was so much wealthier than Hooten had ever imagined threw the doctor’s internal compass off its usual meticulous setting.
Eaton’s mother, like his wife’s mother, had died of complications from Alzheimer’s. Now he and his wife wanted to give money to the hospital to set up a center for Alzheimer’s research and name it after their mothers: Susan Lake and Delores Costello. Hooten was telling Eaton his money could do more. They could broaden it to include Parkinson’s and other degenerative brain diseases striking the elderly. Maybe Hooten should have simply congratulated Eaton on his generosity and put him in touch with the hospital’s fund-raising folks, the smooth-talking, suit-wearing cadre who talked about “charitable remainder trusts” and other philanthropic incantations. He didn’t.
Harding and Eaton were talking about their respective legacies the way they had talked about the relative merits of Glenlivet and Glenfiddich at one of the fund-raisers when the doctor’s pager went off. Hooten did not have hundreds of millions of dollars, far from it, but he, too, was concerned about his legacy. At the end of the day, what did you have to show for a career? A brand-new building honoring your mother was something solid, concrete and glass, with ongoing research that could make its mark on medicine. Hooten had helped train hundreds of surgeons. They were his legacy, a sort of professional progeny far more amorphous than a building. That and his good name, synonymous with an exacting attention to detail and a commitment to the best surgical practices. Maybe he should have remembered that before he rushed from his office for the OR. He didn’t. He was thinking he was too old and too senior to be hopping to every time someone in the OR got antsy.