Then she passed Tina Ridgeway’s home, a large, two-story Cape Cod–style house with faded gray shingles and black shutters. The Ridgeway minivan was there, but Tina’s car wasn’t. Sydney figured her colleague was at the hospital. Sydney prided herself on knowing what was going on at the hospital. Her mind wandered, and she wondered if anything was going on between Ty and Tina. They were spending a lot of time together. Sydney had a sixth sense for these things, and she smelled a whiff of added intimacy between the two doctors.
The thought of work of course prompted Sydney to suddenly stop and check her pager. Nothing. It was no surprise that Sydney hadn’t been able to actually get through dinner and a complete romantic date for the last two years. If the pager went off, she stopped whatever she was doing and rushed to check it. Ross, her last real boyfriend, had gone so far as to buy an engagement ring. He had it in his pocket the night they went to Gandy Dancer, the nicest restaurant in town. He picked an evening when she wasn’t on call and should have had no reason to wear her pager. After she answered it for the seventh time, though, disappearing for thirty minutes, Ross decided the ring was better off in his pocket. Afterward, Sydney didn’t know why their relationship had soured, only that the vision she had of “punching the marriage ticket” as her career powered ahead had vanished with the empty cups of decaf at the Gandy Dancer.
Sydney headed downhill, her legs churning, moving away from the million-dollar homes toward the ranches and teardowns in the next neighborhood over, Sung Park’s neighborhood. Even though he was making a good salary now as a neurosurgeon, he still lived in the same house he bought when he was a resident. She had asked him once if he was planning on getting a bigger place now that he had three children and a better-paying job. He looked at her for a long second, and then said, “Why?”
Sydney’s pager went off. Her pulse quickened. She checked it without breaking stride. It said,
311. 6.
Poor Ty
, she immediately thought.
The bigger they are, the harder they fall
. Ty was the big man on campus in the hospital, and was naturally gifted, but no one escaped Monday Mornings.
I
n the operating room, Ty stood over the twenty-five-year-old woman’s exposed brain. He now knew her name was Sheila, she was a teacher, and she’d been driving home after a long bike ride on the Kensington Park trail. Her father had given Ty these details while her mother sat next to him sobbing. When Ty handed over the consent form for surgery, the reality of the situation hit both parents, and they broke down. Ty had gently put his hands on their shoulders and said simply, “Don’t worry, when she’s in there with me, I will treat her like a member of my own family.” Sheila’s mother wiped her eyes, stood up, and gave Ty a hug. Her father signed the form giving permission for Ty to open up his daughter’s brain with a series of drills, saws, and scalpels.
The rest of her head was covered by a light blue drape, framing the gray tissue visible through a round hole in the side of her skull. It had taken Ty just twenty-five minutes to open the skull, delicately cut the outer layer of the brain, and split the natural fissure between the frontal and temporal lobes. This was arguably one of the most difficult operations a brain surgeon could perform, but no one in the operating room seemed anxious. When Ty Wilson walked into the room, everything seemed to fall into a state of order and calm. Now Ty was carefully peering into the microscope, the bright light reflecting the gray-red brain onto his blue eyes. He needed to clip the aneurysm that had almost killed her earlier that night and could kill her in the days or weeks ahead if he did not disarm it.
The operating room was cold, and Eddie Vedder played over the stereo system: “Just Breathe.” The Northwest grunge music was the choice of the anesthesiologist, a petite doctor named Mickie Mason. She stood next to a bank of devices monitoring the woman’s vital signs. Most surgeons held strong opinions about what music played in the OR when they operated. Truth was, Ty didn’t even hear it when he was in the zone, so he let the gas passer—his affectionate moniker for anesthesiologists—pick. In addition to Mason, a nurse stood behind Ty and slightly to his right, next to a tray of instruments. A resident stood on the other side of the operating table, studying every move of a surgeon considered one of the greatest natural “athletes” ever at Chelsea General.
Ty had cut through the thick, fibrous outer layer of the brain, the dura, with his usual quip: “That’s one tough mother.” The name for this outer membrane of the brain came from the Old English
dura mater
or “tough mother,” a piece of medical arcania passed along by his chief resident during training. The chief resident, now a full professor of neurosurgery at UCSF, where they had both trained, also made this quip at the start of every operation. Ty had performed more than a thousand operations on the brain since training. Still, at the start of each, he’d say, “That’s one tough mother.” It was now part ritual, part homage to his mentor.
Looking through the microscope, Ty could see the optic nerve, a thick white filament stretching toward the back of the skull. Nearby was the carotid artery, one of the major vessels supplying blood to the brain. On the other side of the artery was another nerve, a thread-like strand, almost imperceptible, even with microscopic magnification. “Gotcha,” Tyler whispered to himself. Between the two structures deep in the brain, Ty found what he was looking for, the ballooned side of a blood vessel or aneurysm that had bulged and then burst with such catastrophic results. It looked every bit like a blood blister. Just as Villanueva suspected, the aneurysm was big enough to put pressure on that small strand, the oculomotor nerve, as it exited the brain stem. That was why her pupil had been dilated.
The brain was such an elaborate organ, there were times Ty wondered how it managed to function without complications for as many people as it did. So many things could throw the brain’s delicate mechanisms out of balance, with lifelong, disastrous effects. A vessel could blow and spray blood across the delicate, spongy matter, the command center that controlled everything from breathing to consciousness. A single cell could grow out of control, squeezing out sight or memory or life itself. Lead in the blood, courtesy of a few chips of old paint, could dampen a child’s learning for the rest of his or her life. A shortage of serotonin could result in crippling depression. A blow to the head could cause a bruise to the soft loops and folds of the brain and affect balance, speech, or judgment. The inability to produce enough dopamine resulted in the tremors of Parkinson’s. A severe vitamin B
12
deficiency could cause dementia. The list was almost endless. Protected by a helmet of bone, the brain was an organ of mind-boggling complexity and ability.
During his training, Ty’s chief resident had challenged Ty and the three others who had made the cut into one of the smallest and most challenging subsets of modern medicine. He asked them why they thought they were good enough to operate on “the most complicated structure in the known universe.” That phrase, too, stuck with Ty:
the most complicated structure in the known universe
.
Why, indeed. Ty’s thoughts returned to the page he had received earlier: Room 311. Six o’clock in the morning.
Quinn McDaniel’s mother had not asked him why he felt qualified to operate on her son’s brain. She saw a confident, handsome surgeon, the very picture of what a surgeon should look like. She saw an attending neurosurgeon at a large teaching hospital with an international reputation. She figured everything would be fine. Before walking into surgery, the boy’s mother had called after him, “Doctor. Take good care of him. He’s my…well, everything.” She smiled when she said it, a look of pride on her face.
Ty studied the woman’s aneurysm.
“Straight clip.”
“Straight clip,” the surgical nurse replied, handing Ty the small metal object.
The woman lying on the table in front of him was somebody’s “everything.” A daughter. A wife. A mother. Ty again flashed on Quinn McDaniel’s mother, and in that moment experienced an alien sensation in the operating room: doubt. It was almost like another presence in the room, a shadow looking over his shoulder. He had a slight shudder. Ty had never doubted his surgical skills. He had never had a reason to do so. His extraordinary dexterity, his cool under pressure, and his ability to figure out the three-dimensional puzzle presented by the brain came naturally to him. He could visualize the brain the way some could solve a Rubik’s cube. Ty was grateful he possessed these skills. He had always considered them permanent, immutable. Now he wondered whether he had been fooling himself and others. Maybe he didn’t have these extraordinary talents after all. Just ask Allison McDaniel.
Ty’s pause broke the rhythm of the surgery, and the nurse looked at him, concerned. The break was unusual, out of the ordinary, and anything that deviated from the expected was cause for concern in the operating room. The resident, who had been leaning over, peering intently through the microscope at the operating field, stood up straight. He, too, looked over at Ty, wondering what the maestro was up to.
“Nancy, I think I’ll go with a fenestrated clip instead.” Ty handed the nurse the straight clip. He then took the other one. He turned to the resident.
“What do you think, Jason, fenestrated?” The question caught the resident by surprise. It was as though the all-star quarterback had just asked the third-string signal caller what play to call with two minutes left and the outcome of the game hanging in the balance.
“Um, sure, Ty. Fenestrated.” Ty paused, and then nodded. The nurse placed the instrument in his hand, and he let out a silent breath. He counted to ten in his mind as his right hand directed the clip onto the blistered aneurysm. Barely perceptible were millions of micro motions between his thumb and forefinger coordinated with his wrist, all happening at lightning speed. And the clip was placed perfectly.
The rest of the operation was uneventful. Ty left the OR more tired than he should have been by what was a straightforward procedure for him. Two things were picking at his consciousness: the doubt he had experienced back there, and the page he had received earlier. The doubt was troubling, but he tried to push it from his consciousness as a freak and ultimately irrelevant experience. A rogue wave. He had never experienced doubt before and probably never would again, he reasoned. The page was far more disturbing. He would be answering for Quinn McDaniel in the morning, and he needed to be ready. Most of all, he needed a good night’s sleep, but he knew the fatigue he felt as he traded his scrubs for a lab coat would not help. A good night’s sleep was impossible. Room 311. Six o’clock in the morning.
R
oom 311 was dim except for a bank of overhead lights focused on the front of the small auditorium. Ty Wilson stood in the band of light. Dressed in blue scrubs and a crisp white lab coat, he clasped his hands behind his back, giving the impression he was relaxed. Just waiting to talk to some of his friends on a Monday morning. Above his left pocket was his full name and
DEPARTMENT OF NEUROLOGICAL SURGERY
, written in neat cursive. There was nothing in any of his pockets.
Truth was, Ty was anything but calm. He was nauseated as the epinephrine coursed through his blood and constricted the blood flow to his stomach. He tried breathing deeply and slowly, exhaling through his mouth, but his respiration was faster than he wanted, and even before he spoke Ty had started to sweat, ever so slightly, and beads started to form on his upper brow. He was experiencing a reflex that had been preserved throughout all evolution in every single animal species, including humans. Fight or flight.
Apocrine
, Ty thought, marveling for a moment on how this word from medical school had bubbled into his consciousness on this of all mornings. As medical students learned, there are two kinds of perspiration: eccrine, the healthy, cooling sweat of exercise, and apocrine, the hormone-drenched sweat of fear. Ty had little doubt his body was excreting apocrine.
Dogs could smell fear and desperation. Women could, too, as far as Ty was concerned, although he’d reached this conclusion primarily through observation. He’d watched friends, college roommates, med school classmates—intelligent, perfectly reasonable-looking men—who gave off the whiff of desperation, and women could sense it even before his friends opened their mouths. Ty was sure he now gave off the whiff of fear, and his colleagues’ olfactory glands three rows up were getting doused with apocrine. He was usually the cool observer, not the doc on the hot seat.
Ty had the irrational urge to simply bolt up the stairs and not look back. Turn right, sprint past Radiology, down the stairs, take a left, pass the pharmacy and the gift shop, through the marbled lobby, and out through the revolving doors, escaping the orbit of the sprawling twelve-story hospital the way a rocket breaks the earth’s gravitational pull. He’d pass the valet stand, the smoking patients from the lung cancer ward with their IV poles and their oxygen, the waiting relatives, the lingering vagrants. He’d pass Stan the sleeping security guard, the small food carts and trailers circling the hospital like satellites and serving everything from doughnuts to Chinese food, and run into the garage, where his Aston waited. He’d peel out of the garage, turn left on Linden through town, past the lakes, get on the interstate heading south, and not look back. Surely a hospital somewhere in Mexico or Costa Rica or Chile would value his training and skills, if not his choppy Spanish. Ty could almost see himself practicing somewhere else. Almost. But the inchoate picture in his mind’s eye never fully materialized. He didn’t want to be playing in the minors.
Ty could feel his fists tensing and his muscles swelling with more blood flow. He began fidgeting, tapping his feet. No question, Ty wanted to take flight, but that was not an option. Monday Mornings at Chelsea were the main reason he’d picked the hospital. Ty looked around Room 311, filled with sixty doctors or so, all the surgeons in his department. No one was skipping this particular meeting. They were seated in an ascending arc around Ty. Many of them held large cups of coffee, but they didn’t take their eyes off him. It was as though they couldn’t believe what they were seeing: Ty Wilson standing where no surgeon wanted to be, waiting to explain his mistake. You couldn’t get to that spot without something going horribly wrong.