Hooten turned back toward Ty.
“Let me ask again…Dr. Wilson, what would you have learned if you had taken a detailed history before surgery, including the boy’s biological father?” Ty wanted to hate Hooten at this moment, but he couldn’t. He knew the old doctor was right. Ty knew he was wrong, and the costs of his mistake could not be calculated in any meaningful way. A boy had died sooner than he had to. “Dr. Wilson?”
“I would have learned the boy had a fifty-fifty chance of inheriting von Willebrand disease and had a risk for uncontrollable bleeding. I would have learned—”
The back doors to Room 311 flew open. Ty stopped. The assembled surgeons looked back: George Villanueva. He strode forward, gave Tina Ridgeway a little shoulder rub, and then looked up at the Boss.
“Hey, what did I miss? Did pretty boy explain how he killed the kid yet?”
T
y flinched noticeably, but then was transported back to the night he’d last seen Quinn. With the persistent bleeding, the anesthesiologist had long since dispensed with his newspaper reading and was peering frantically over the sterile drape that separated surgeons and sleepers. The music had been turned off some time ago. “Uh, Ty,” he whispered so the boy wouldn’t hear him, “…we have three blood transfusions going, and we can’t keep up. His heart is starting to fail.” Ty shot him a glance and then motioned to put the boy to sleep. Syringes were pushed and a tube was placed in the boy’s mouth. Ty was back at work, aggressively trying to stop the bleeding in a boy whose blood would simply not clot.
What…is…happening…?
“Chest tray!” Ty shouted to the now-assembled group of a dozen nurses. He was going to attempt a last-ditch effort to save the boy. He would open up his chest and begin an open-heart massage. He would pump the boy’s heart until they could get enough blood in him.
Ty’s hands were flailing wildly as he was describing everything to the surgeons in the secret meeting room. He had almost forgotten where he was, until a stern voice jarred him back to the present. Room 311, just after 6
AM
.
“Did you really think that would work?” Hooten asked.
Ty looked momentarily confused and then met his inquisitor’s eyes head-on. “No, sir, I didn’t.”
A
fter the boy died, Dr. Tyler Wilson walked numbly into the locker room. It looked every bit like a room you would find in a gym. One of his favorite technicians was in there and cheerily asked how things had gone with the boy. Ty stared at him blankly and said nothing. “Oh …sorry. Well, you can’t win them all,” the technician said softly as Ty sat down and began to take off his clogs. He was soaked to the skin with young Quinn’s blood. His feet were damp from the blood that had seeped through the small ventilation holes in his clogs. He removed all the bloody clothing, including his underwear, which were red-tinged, and threw everything in the hamper. In the small adjoining shower, he scrubbed his skin till it was raw, trying to cleanse himself of the blood and his despair. He changed into a shirt and tie. Most of all, he did not want Quinn McDaniel’s mother to see any traces of her son’s blood. By the time he walked out of the locker room and into the empty waiting room, it was nearly four in the morning. Only Allison McDaniel was sitting in there.
She looked into his eyes, and she knew. Her face collapsed.
The sight of her struck Ty like a blow. He wanted to turn around. He knew other surgeons who sent their residents out to let family members know a loved one had died. That would have been easy. He could have moved on to the next case with barely a glance back. But Ty had vowed years earlier—after what had happened when his own brother and later a sister died—that he would give the bad news himself, no matter what.
Ty remembered his mother’s face in a hospital three thousand miles away and thirty years earlier when she got the news about his brother, Ted. A brain tumor had been diagnosed just a few months earlier, and he had fought like crazy. He had been young and healthy, and then he was suddenly dead. She didn’t learn of his death from the surgeon but a hospital social worker. For some reason, this seemed to make the news both harder to comprehend and harder to take. In both cases, Quinn McDaniel’s and Ted Wilson’s, the searing grief had an almost physiological effect on the mothers—as though their features collapsed with their faith in the world. The cheeks and muscles around their mouths seemed to drop with the weight of the news. The color left their faces. Their bodies sagged.
Ty was with his mother at the time. He was eight. His father and two sisters had gone out to pick up some food. Watching his mother in her moment of grief was much more upsetting to Ty than the news of his brother’s death, which he didn’t understand at first.
“I’m sorry, ma’am, your son didn’t make it through surgery” were the words the social worker had spoken that day three decades earlier. Ty didn’t know what that meant. Was Ted back in the hospital room with the cool bed and the TV bolted to the wall? Ty hoped so. He never told his parents, but he had hoped his brother would get to stay in the hospital forever. Whenever he visited his brother, Ted would ask if he had an E Ticket. Ty would hand him a make-believe Disneyland ticket and climb up on the bed, and Ted would hit the buttons to make the sections of the bed rise and fall. Watching his mother, he knew something much, much worse had happened, though he wasn’t sure what. He could not imagine life without his big brother. The notion of Ted dying was not even in the realm of the possible for young Ty, who idolized his older brother to the point of mimicking his pigeon-toed gait and squinty stare.
The tragedy devoured his parents’ relationship. His father would disappear for long stretches. When he was home, he said little. He wandered around their small home as though he were lost. His mother dove into work. She was a realtor and spent most weekends driving clients around Southern California. She specialized in first-time home buyers even though the commissions were smaller and financing was often a problem. Ty wondered if she somehow liked being around the hope these young couples carried with them. His parents’ marriage didn’t last long after Ted’s death. Maybe a year or two. Their bond eroded and then collapsed under the burden of the grief.
When Ty was a teenager, his mother and father reunited briefly in another ER for another family tragedy. They were in their late forties but looked much older. Even though they were both remarried, they hugged for a long time when they saw each other. They shared a rare and horrible bond: a parent’s grief multiplied now over two children. Ty’s sister Christine was already in the OR undergoing emergency surgery when they arrived. Christine had been standing in line at a convenience store waiting to buy a Coke and some gum. All of her friends were outside waving to her when they had seen a man enter the store in a hurry.
“It seemed like just a moment had passed when we saw a few bright flashes of light and heard a loud noise,” those friends of Christine had told Ty’s parents. The gunman had never been found. He had left two people dead at the scene and Christine with a devastating bullet hole in the back of her brain. The prognosis was not good.
When the young neurosurgeon emerged, he informed Ty and his parents drily that Christine had lived but would be in a vegetative state for the rest of her life. His tone was so clinical, so cold, he could have been a service rep at the local car dealership telling them they needed new tires. In that moment, whatever flicker of life remained in his parents extinguished. They breathed, their hearts beat, but the spark of life was gone.
At the time, though, the news had the opposite effect on Ty. It transformed him, awakened his drive, gave his life purpose. His brother’s death years earlier triggered in Ty an outrage at the callousness of the surgeon and a fury at the unfairness of the world, a rage that made Ty a volatile teenager. He was easy to anger and indifferent about school. His sister’s state sparked in Ty something else entirely: a desire to be a neurosurgeon who could save patients and render them functional when others could not. From that moment on, Ty approached life with a single-minded purpose that made him a top student and eventually one of the best neurosurgeons in the country. Ty never forgot about the way his family had been treated, though. Doctors had ducked out when they should have been talking to Ty’s mother. He never forgot how much a doctor’s lack of compassion had added to his mother’s pain. It was no surprise, then, that while Ty could be remarkably arrogant to his colleagues in medicine, with his patients and their families a remarkable humility and compassion emerged.
Standing in front of Allison McDaniel with the worst news he could give her, Ty’s thoughts returned to those California hospitals: the news of his brother’s death delivered casually by a hospital bureaucrat, his sister lying in a sterile long-term care facility, and his subsequent vow to be the surgeon who could save the impossible cases. Ty had become aware tears were burning a path down his cheeks. “Things didn’t go so well in there, did they?” Allison asked softly. Ty cleared his throat. “No, ma’am,” he replied softly. “I am afraid we lost your son tonight.” Allison started to sob, and Ty took her hands into his own.
“I know you did all you could,” Allison said. Ty was too choked up to answer. Allison McDaniel walked over to him and gave him a hug. Ty found the embrace comforting and somehow unnerving: Chelsea General’s star surgeon needed comforting from the mother of the patient he had just killed. That was how he saw it. Allison slowly collected her belongings and started to walk out of the room. Just before leaving, she turned. She wiped away a tear while looking at Ty and said, “I know what happened in there must’ve been so hard for you.”
A
round the corner, nurse Monique Tran had also been in tears. She was calling her boyfriend from a quiet corridor.
“I’ve decided to keep the baby.” With that, she couldn’t say any more. She hung up.
M
itchell S. “Mitch” Tompkins checked the notes on a yellow legal pad and fingered a diamond-crusted gold band on his right hand. He gave a little tug on his Italian suit coat and turned a set of too-shiny white teeth toward Tina Ridgeway. Tina sat upright, legs crossed, her elegant hands folded in her lap in an effort not to show how uncomfortable the deposition was making her. She wore scrubs, sneakers, and her spotless white coat.
N
ow, Dr. Ridgeway, before the surgery, did you tell Mary Cash exactly how you planned to destroy her sense of smell?”
Tina returned the stare, winced slightly, and took a deep breath.
“Of course not. We didn’t plan anything of the sort.”
“You did it anyway, though. Didn’t you?” Tompkins pressured.
Tina paused, and tried to choose her words carefully. “No operation is without risks.”
Tompkins paced the conference room on the twelfth floor of Chelsea General when he talked. Like the rest of the floor, the room was elegant, with a cherry-and-oak table and high-backed leather chairs all around. A few of Hooten’s paintings hung on the wall, along with gold-plated light sconces. It was perhaps the worst place to hold a malpractice deposition, but Tompkins had insisted and the hospital lawyers had relented. Tina closed her eyes and tried to remain calm. If Mitchell S. “Mitch” Tompkins planned to rile her up, he was succeeding. She had seen the man’s name before. It was on the back of every phone book, above a picture of him surrounded by concerned-looking patients.
HAVE YOU BEEN WRONGED IN AN INJURY? HAVE YOU HAD A BAD MEDICAL OUTCOME?
Tompkins didn’t look as good as the picture. In the photograph, he gazed at the camera with a confident air and the hint of a smile. Somehow, the picture made him look tall. In person, he was medium height and build. His handsome features were a little puffy, his face pale, with dark circles under his eyes, but he had swagger, and he was using it right now.
He was perched under an expensive chandelier. “You say no surgery is without risks. So then of course, before the operation you told Mary Cash about the risks?”
“Yes.”
“You, personally—”
“All our patients sign a consent—”
“Did you see her sign the consent? Did you personally see her sign the consent?”
Tina looked over at the hospital’s lawyer, who was reading his BlackBerry. The stenographer looked at Tina, waiting for her answer.
“Usually, that’s the responsibility of the resident, to go over the risks with the patient and have the patient sign the consent form.”
“So for all you know, Mary Cash didn’t even sign the consent.”
“I’m sure she signed it.”
“But you didn’t see her sign it. How can you be sure that’s her signature? It could be anyone’s.”
The hospital attorney looked up, interested the way he might find someone walking down the street with a black eye interesting, and then returned to his BlackBerry.
“Yes, but—”
“For the record,” Tompkins said, looking at the stenographer. “You are telling me you have no idea what risks—if any—Mary Cash was told of before this surgery.”
“We could ask—”
“Yes or no? Do you have direct personal knowledge of what risks Mary Cash was aware of before her surgery?”
Again, Tina looked to the hospital attorney.
A four-hundred-dollar-an-hour mute
, she thought. Shouldn’t he object or something? Was she supposed to endure this meekly?
Tompkins leaned close to Tina. He was enjoying every minute of this. He folded his arms in a practiced way, like someone on Broadway who wanted to make sure the folks in the back row didn’t miss the gesture.
“I have all day, Dr. Ridgeway. Yes or no.”
“No,” Tina said, deflated. “I did not personally hear what Mary Cash was told before her surgery.”
Tina tried to imagine what her father, the renowned internist Thomas Ridgeway, or grandfather, Dr. Nathaniel Ridgeway, a crusty family practitioner in Vermont, would do with the plaintiff’s attorney now in her face. She couldn’t picture either of them sitting where she was at all. They would have gotten up and walked out without a second thought.