Then she thought of McManus. She was picturing him as a father when there was a quiet knock on the outside of her door.
“Your ears must have been burning. I was just thinking about you.”
“Really? I thought you had to talk about someone to have their ears burn.”
“Don’t believe everything you read in the
Archives of Internal Medicine
.”
“You’d probably have some sort of surgical solution for ringing ears. Resecting the ear, maybe.”
“Very funny.”
“I digress. Would you like to have a celebratory dinner tonight? My place?”
“Sounds good,” Sydney said, thinking
his place
. The relationship was entering the next stage, and Sydney was looking forward to it.
As he turned to go, McManus pointed to a picture on the shelf above Sydney’s desk. In it, she was standing next to Hooten. They almost looked like twins, posing the same way as they did.
“Where’d that picture come from?”
“I don’t know.”
“Looks like he left it for you.”
“Yeah. I’m sure he did. But how could he have possibly known the board would name me?” Sydney’s voice trailed off.
It was time for a new era at Chelsea General. On her computer, she typed “Prevalence of Wrong-Sided Craniotomy for Brain Trauma.” Then she went to the central paging site and paged everyone in the department.
311. 6.
E
ven though it was a Thursday, Sung Park decided to take the day off and let the residents take clinic. The chemo hadn’t made him overly tired, nor did he feel nauseated. He just wanted to stay home. The girls had started their winter break from school, and he felt a tug to be with them. The day was impossibly warm for December, pushing seventy degrees, and the girls were in the small backyard playing with their brightly colored hula hoops. Sung marveled at how their lithe bodies could keep the hoops spinning seemingly indefinitely above their narrow hips.
The girls smiled when they saw Sung watching them through the kitchen window.
“Daddy, look!” they called.
A month or so earlier, Park might have admonished the girls to do something useful with their time: to read a book or practice their violin or cello. Something that would help them later in life. Something that would prepare them for the future. Now he walked outside with a glass of orange juice, sat down on a deck chair, and watched them.
Park’s two-year-old son wandered out of the house and tried to grab the spinning hoop orbiting around his older sister Natalie. She stopped and handed him the hoop. The boy studied it, confused. She put it over his head.
“Like this,” Emily said, and demonstrated. He let go of the hoop and gyrated. The plastic disk fell to the flagstones. The girls laughed. He tried again. Once again, the hoop dropped.
Four-year-old Natalie leaned over. “Ready,” she said. The boy took on an exaggerated look of concentration. “Go!” She pushed the hoop to start it moving around his small waist. He gyrated wildly. The hoop dropped.
“I did it,” he cried out. “I did it.”
As Park watched from the chair, he thought there were some things in life you could not prepare for. A brain tumor, for example. Your children idling on a balmy December day, for another. These were the moments to learn from and to savor.
Park tipped his head back to feel the sun. His mind wandered to his language tapes.
“
Savor: to taste and enjoy completely.
”
B
y Tina’s calculation, she had about a twenty-four-hour drive ahead of her and the rest of her life to figure out how everything had gone wrong at Chelsea General. It had been nearly four months since K. C. Ruby had nearly killed her. It turned out he had also assaulted his girlfriend that night—the same one George Villanueva had rescued while his scared son looked on.
Thanks to brain monitors, diuretics, and mechanical ventilation as well as months of cognitive and physical rehabilitation, she was finally back to 50 percent of what she once was. The one thing she was given was a lot of time to think, and she had made some big decisions.
She was looking forward to practicing medicine in a small office in Vermont, the way her grandfather had. The way her father was now practicing medicine in his “retirement.”
Tina’s plan was to charge fifty dollars cash for basic doctor visits, eliminating the mountain of paperwork, the billing, the insurance companies peering over her shoulder, measuring how many patients she should see in an hour, telling her what she should and should not be doing. Also, despite Vermont’s reputation as some sort of green utopia, plenty of people there lived hand-to-mouth and did not have insurance. They were self-employed or day laborers or part-time and needed someplace to go for their basic medical needs.
A wave of excitement ran over Tina at the thought of delivering babies again. She had done an OB rotation in medical school, and she remembered the thrill of bringing new life into the world, messy, squalling, joyful life.
Tina nosed the car onto the highway. She imagined her colleagues’ cortisol levels rising steadily, as her own had, every time she entered the hospital in recent months. Tina thought about the competition to get into medical school; the competition to get the best grades and score points with the most influential professors; the competition get the best residencies; the competition to get the best fellowships; the competition to get a position at a teaching hospital. The competition to become a department head. Always jockeying. Always pushing. Always trying to get ahead. Ambitions. Politics. Egos. She had competed with her peers and, for the most part, she had succeeded, but where was the practice of medicine in all this? Where were “the healing arts,” as her grandfather liked to call them?
Tina was on the interstate now, heading toward her future at seventy-five miles per hour.
Maybe, Tina thought with a moment of alarm, her vision of medicine was idealized, infused with the saccharine glow of a child who sees a grandfather and father as fonts of great wisdom and stature in their communities. Maybe they, too, had faced profound disappointment in their professional lives, or concluded that the practice of medicine was not what they’d imagined. She didn’t think so. She had never heard them talk about medicine as anything but a noble calling.
At home, they became animated when their conversations turned to vexing cases. They tossed out possible diagnoses, possible treatments. Tina remembered vividly one of her grandfather’s patients, an elderly woman named Violet. Tina was nine and spending the month of July in Vermont. Tina loved the name Violet. She wanted to change her name to Violet when she was old enough, so she paid close attention to the woman’s case. Violet complained of aching joints and muscle pain. At first her grandfather thought it was fibromyalgia. He recommended warm compresses and exercise, although Violet walked almost everywhere already. Her aches continued. One day, her grandfather came home with a smug look on his face.
“Did your mother or father ever make you drink cod liver oil as a punishment?”
“Cod liver oil? Sounds gross.”
“We made your father drink it when he didn’t mind his parents.”
“You did?”
“Tastes awful.”
“It sounds like it tastes awful.”
“Today, I made Violet Olson drink cod liver oil.”
“She didn’t mind you?” Tina asked.
Her grandfather laughed. “No, it wasn’t that. She drank it to make her feel better. And you know what? She started feeling better. Her problem all along has been a vitamin D deficiency.”
Tina remembered her grandfather’s pride that he was able to outthink this elderly woman’s joint pain and muscle aches. That there was a simple remedy to her symptoms made her case even more satisfying—so satisfying he had to share it with his nine-year-old granddaughter. So many of Tina’s colleagues talked about other things. They became animated when they talked about reducing the percentage of costs devoted to overhead or Medicare reimbursement rates or real estate investments.
As she drove south around Lake Erie, Tina again questioned her decision. Before she left, she and Mark had agreed they would split amicably. No lawyers with their cutthroat tactics and exorbitant fees. Ashley was coming with her. The girls would stay with Mark until the school year was out before spending the summer with Tina in Vermont. Tina knew this would not be easy on the girls, but living in a home where Mommy and Daddy are fighting—or, worse, where they simply don’t care anymore—that had to be worse, didn’t it? Tina certainly hoped so.
Tina heard a keening in the backseat. Ashley had thrown her head back. Tina turned on the car radio, and Ashley happily banged on her tray. Tina welcomed the challenge of caring for Ashley. She didn’t consider it a penance but a gift. She knew she could do it well, and she looked forward to connecting with this girl who had been to this point, if Tina was really honest with herself, little more than a responsibility she had accepted.
Tina’s father had been reserved when he’d heard the news. He was no doubt excited his daughter would be joining him, but was silent for a long time when Tina told him that she was coming with Ashley and leaving Mark and other girls behind. He and Tina’s mother had been married forty-two years before she had died of breast cancer a couple of years earlier. They shared not only love, but a fierce loyalty. Her father felt the same way about his patients. He felt the same way about Tina, for that matter, and even her brother, who had struggled with alcohol and drugs after failing to follow in the footsteps of his father and grandfather. He now worked in a bike shop in Vermont.
Tina was approaching the Ohio state line.
How many more states to go?
Tina wondered idly. Before she could work it out, another thought intruded: She was heading home. Toward her roots, her birthplace, her family. She was driving toward her past.
E
ven now, 13 months after the funeral, a pall hung over the Emergency Department. Dr. Kauffman, better known as Dr. Um-So, sat on Villanueva’s stool as the docs went about examining a cracked skull, a sprained ankle, an odd rash, a delusional psychotic, a febrile child, a nauseated woman. Kauffman thought he should ease the loss those around him felt by thundering around the room like the Big Cat, roaring profanity, insults, diagnoses. He knew he could no more pull it off than he could wear the size XXXL scrubs.
There was a crackle on the radio behind him. Kauffman didn’t quite believe what he’d heard, so he asked the paramedic on the incoming helicopter to repeat. Kauffman went pale.
“Um so, page Dr. Wilson,” Kauffman said. “This one will loosen even his sphincter.”
When his pager buzzed, Ty Wilson was sitting in the call room, legs crossed, back straight. The lights were out. His eyes were shut. He took in a deep breath through his nose, held it, and released the air slowly through his mouth. The pager buzzed again. Ty took another long, slow breath and stood up. He looked at the pager:
Um-So wants you. Now
. He called the ER then quickly grabbed his coat and made for the roof via the stairwell, two steps at a time. He had never seen a traumatic atlanto-occipital dislocation. This kind of internal decapitation was almost always fatal. The connection between the spinal column and the brain stem would be severed, and the respiratory arrest would follow quickly. Hangmen through the ages counted on this simple equation.
The teenager coming in on the helicopter was incredibly lucky. First, that he had survived the initial ATV accident. Second, that he had survived the trip to the hospital. His father and brother had carefully lifted him into the back of the family’s pickup truck. Somehow, they managed to move him there without killing him. To make him comfortable, they had placed his head on a pillow. If they had called 911, and the paramedics had placed him on a standard trauma board, the boy might not have survived. Straightening his cervical spine beyond its natural curve might have been enough to kill him. In the helicopter ride from the county hospital, his head rested on a sandbag.
Ty spoke on his cell phone with the radiologist who had seen the CT scan.
“You got yourself one lucky son of a bitch inbound,” he said. “Emailing you the scans now. Possible subluxation at the time of the trauma. When he arrived at the ED, the CT showed a subarachnoid hemorrhage at the craniovertebral junction. Definitely AOD.”
“Thanks,” Ty said. “AOD is a lot better than DOA.”
“Ha! You got that right,” the radiologist said. “Kinda spooky, though, the head up there hanging by a thread.”
“Appreciate your help,” Ty said. He was on the roof now and heard the throbbing of the rotors getting louder. He took a deep breath through his nose and breathed out slowly through his mouth.
Ty could see the helicopter now. It descended slowly toward the roof, its tail twisting in the wind, the sounds of the engine and the rotors echoing off the small landing pad, the prop wash blowing Ty and the ER nurses who had also come up to the roof.
Ty ran through his plan. First, get his own CT of the patient, along with a craniocervical MRI. He wanted to make sure he knew exactly what he was dealing with.
Then Ty planned to put a halo on the boy’s head to completely immobilize it. Any movement at all could kill him. Once he had the kid in the OR, he planned a craniocervical fusion.
Ty thought about calling in one of the other neurosurgical attendings, but he was the last one standing. Hooten was gone. Tina was gone. Park was out of the picture. After years of relative stability, the ranks of the neurosurgical unit at Chelsea General had been decimated in a matter of months.
Still, if there was one thing Quinn McDaniel’s case told him, he was not an island. He was not the Lone Ranger. His skills alone were not enough. Ty paged chief resident Mac Ryan and told him to bring his best senior.
“This is going to be one for the books,” he said. “Oh, and let’s make sure we get all his labs checked, especially his coagulation function.”
Quinn’s protocol
is what Ty called it.