Her thoughts turned to Mass General. One of her favorite memories of childhood was playing hide-and-seek with her father and older brother in the Ether Dome, a semicircular surgical amphitheater where anesthesia was demonstrated for the first time. Her father was always “It.” They would scatter to different curved rows and crouch behind the white, wooden partitions, trying not to squeal or giggle as his footfalls approached. Afterward, when the vapor lights had come back on, her father would take them into his adjoining office in the Bulfinch Building, crouching to fit his six-foot, four-inch frame under the arched doors built when the average American was a good deal shorter and the hospital received patients by boat. There the eminent Dr. Thomas Ridgeway would reach into the large square freezer next to a lab bench and pull out paper-wrapped ice cream sandwiches for his children from among the tissue samples.
His co-workers would make a fuss of Tina and her brother. They’d always ask her brother, “Are you going to be an important doctor like your father?” Over time, she became increasingly annoyed that the lab techs and other doctors never asked her this question. Maybe her resolve to become a doctor began then. Even if it hadn’t, the burden of continuing the family’s legacy in medicine fell to her as soon as her brother dropped out of college. From that point on, her father and grandfather assumed Tina would be going to medical school and becoming the next Dr. Ridgeway in the family.
The deposition was now entering its second hour with no letup in sight. The facts were straightforward, but the lawyer appeared determined to wear down Tina, to get her to say something careless. Something he could have her read out loud at the trial, no doubt, Tina thought. She’d watched enough legal dramas on television to know how this would play out if she lost her cool and so, apparently, had Tompkins.
Mary Cash had arrived at Chelsea General with a meningioma, a benign tumor that could be removed surgically. One of the possible risks was damage to the olfactory nerve that ran near the cancerous growth. If that was nicked or cut, the patient would lose the sense of smell. The patients who heard about this potential side effect often dismissed it without a second thought. Compared with a tumor growing in their brain, smell was nothing, they reasoned. But smell was perhaps the least appreciated of the senses. For the unfortunate few who did lose it, the change could be dramatic. They’d lose the ability to smell the bloom of flowers or the smell of bread baking or fresh-cut grass. Possibly most upsetting, though, was the realization that when you could no longer smell your food, it never tasted as good. As a consequence, many would eat less, lose weight, and appreciate life less.
That’s where Mitch Tompkins came in. He was suing Chelsea General, Dr. Tina Ridgeway, resident Michelle Robidaux, and every other doctor or nurse who had so much as looked at Mary Cash. If it weren’t for the outrageous sum Tompkins was demanding, the hospital would have settled by now. Tompkins wanted twenty-two million dollars: one million for failure to adequately warn Mary Cash of the risks, one million for damaging the nerve, ten million for lost earnings, and ten million for loss of “hedonic pleasure.”
Hedonic pleasure
was a catchall phrase referring to life’s enjoyment. Plaintiff’s lawyers used it if the outcome of their treatment left them unable to walk, see, play golf, have sex. You name it. There was even the case of a woman who had a small bone lodged in her throat that escaped the attention of the ER doc. She claimed the injury sustained resulted in her inability to perform fellatio, proving that any and all of life’s pleasures could be included as Exhibit A in a malpractice suit.
Unless the hospital came close to his demand, Tompkins promised to take the case to trial and slather on the sympathy for Mary Cash like butter on corn bread. His ace in the hole: Mary Cash was a James Beard Award–winning chef. She needed her sense of smell to work. A chef who couldn’t smell was like an artist who couldn’t see. Cases this strong came along once a decade.
“When I get through with this hospital, people bleeding to death will drive an hour out of the way to avoid Chelsea General,” Tompkins promised the hospital attorney after he filed suit at the Oakland County courthouse. “And forget about the bonuses for the hospital executives. That money’s going to pay off the suit. Remember, the jury isn’t limited to awarding twenty-two million.” A third of twenty-two million dollars, of course, was seven million and change. That was Tompkins’s cut. Like shooting fish in a barrel.
In the conference room, Tompkins paced, barely able to contain his glee. He ran his fingers over the expensive hand-screen-printed wallpaper.
“Now, Dr. Ridgeway, tell me how Mary Cash’s career was destroyed. Walk me through this. How do you go about cutting someone’s olfactory nerve?”
When she was growing up, doctors were revered in the community. They were healers, civic leaders, wise men—and they were mostly men. They didn’t make as much money as many specialists these days, but patients treated their word as the gospel. They didn’t Google their symptoms and arrive at the doctor’s only after the supplements or other pop remedies failed. And if something went wrong, it was God’s will, fate, or simply bad luck. Tina couldn’t remember her father facing a single malpractice suit in his forty-year career.
Tina narrated the operation step by step for the plaintiff’s attorney. She had explained the procedure dozens of times for med students, so it was second nature. After the patient’s head was immobilized, an incision was made on the scalp and the skull was exposed. Then a burr hole was perforated behind Mary Cash’s right eye. The hole allowed a larger hole to be sawed in the young woman’s skull, which gave the surgeon access to the brain. From there, it was a matter of gently cutting away the outer layers of the brain and then resecting the tumor. Because a meningioma can sit so close to the olfactory nerve, there is always the danger of nerve damage.
Tompkins was sitting during Tina’s narration. Now that she had finished, he was standing again.
“Very interesting, Dr. Ridgeway. Fascinating, really. You described it so well, I almost feel as though I can do the surgery myself.”
Tina said nothing.
“Now, when you say, ‘A burr hole was made,’ or ‘The tumor was resected’—who was doing the cutting and resecting on Mary Cash? I’m assuming it was you. After all, you are an attending physician, the surgeon of record, and you wouldn’t want to give this talented, James Beard Award–wining chef second-class treatment.”
Tompkins paused and looked at the hospital attorney. The attorney tried to give Tompkins a
what-me-worried
look, but he did look a little worried. Tompkins turned back to Tina.
“So, you were performing this surgery, right?”
“No,” Tina answered.
“No?” Tompkins feigned surprise. “All right then, who was operating on this young, talented, attractive chef with a whole career ahead of her, a rising star in the culinary world?”
“Dr. Robidaux.”
“Dr. Robidaux?”
“Yes, Michelle Robidaux. A resident in the Department of Neurosurgery.”
“You mean, you allowed a doctor in training, a student if you will, to operate on the brain of this young woman, lying defenseless on the table, as she was, her trust entirely with you?”
“This is a teaching hospital, Mr. Tompkins.”
“So, what you’re telling me is that Mary Cash was cannon fodder. Someone for Dr. Robidaux to practice on.” Tompkins almost spat the name
Robidaux
. “My client was a guinea pig, if you will? Sort of like the Tuskegee syphilis experiments.”
Tompkins was in full trial mode now, even though it was just the four of them in the room with him, the two lawyers, Tina, and the stenographer. His inflection wouldn’t show up in the deposition transcript, but the plaintiff’s attorney was giving the hospital’s counsel a heaping taste of what his courtroom questioning of the esteemed Dr. Tina Ridgeway might sound like if the case went before a jury.
Again, Tina looked over at the hospital attorney. He was paying attention now. No more messaging on his BlackBerry. Still, he remained mute, making a few surreptitious notes on a legal pad. Tina wasn’t sure which was worse, indifference or concern.
“Dr. Robidaux is a competent doctor.”
“Competent,” Tompkins repeated as though he were clearing bile from his throat. “Competent. When I go to get my brain operated on, I don’t know about you, Dr. Ridgeway, but I want more than competent. I want an outstanding surgeon operating on my brain. Competent. Huh!”
Tina was flustered now.
“What I mean to say, Mr. Tompkins, is she is perfectly—”
“Did I ask a question, Dr. Ridgeway?” Tompkins interrupted. He turned to the stenographer. “Strike the doctor’s previous
ex parte
commentary.” He pivoted on his heels back toward Tina, looking a little like a game-show host with his thousand-dollar suit, expensive haircut, and extensive grooming.
“How was it that Dr. Robidaux was chosen to operate on my client?”
“That was my decision. I thought she was perfectly capable of handling a meningioma—”
“And she needed the practice?”
“No.”
“Well, how many of these had she performed, before she cut on my client?”
“I’d have to check—”
“I think you know perfectly well. How many, Dr. Ridgeway?”
“None.”
“None!” Tompkins looked as though he had just had the last bite of a delicious meal and was about to signal for the check. “None,” he said again, shaking his head. “That’s just rich.” The lawyer’s expression at that moment was the very epitome of smug.
Tina reddened. Her restraint fell away. Full-blooded anger replaced it.
“That’s what a teaching hospital is, Mr. Tompkins. You know that as well as I do. We have the best doctors in the world because we have teaching hospitals. Residents learn at teaching hospitals. No one hatches from an egg as a polished surgeon.”
Now the hospital attorney looked alarmed. He tried to interrupt. “Tina.”
“One patient may suffer, but Dr. Robidaux is a better doctor, a better surgeon for the scores of others she’ll treat in the years to come.”
“Tina!”
Tina ended her diatribe. Tompkins turned to the stenographer.
“Did you get that?
V
illanueva rolled up toward the massive suburban home. Looking at the enormous brick structure, with its white-columned portico, fountain, and circular drive, George was amazed he’d allowed his ex-wife to convince him they needed to buy such an ungodly monstrosity. What was he thinking?
He couldn’t see any lights on in the house, but that was nothing new, either. The whole neighborhood looked as if it had been hit by a neutron bomb. Not a sign of human life anywhere among street after street of McMansions in Bloomfield Hills. If you have seven thousand square feet of living space, who needs to be outside playing or, God forbid, rubbing shoulders with the neighbors? Never mind that it was a perfect fall day, or that many of the lawns were so well groomed you could get out your clubs and practice your short game on them.
In Villanueva’s hometown, Dexter, Michigan, you were lucky to have a small patch of grass in front of your house, and if you did you kept it behind a chain-link fence. Kids in Dexter generally played in the street or at the ragged park at the edge of town. They played until dinner or until dark and sometimes later. Football. Baseball. Basketball. Wrestling. It didn’t matter. There were constant tests of athletic skills, of toughness. And there were dares, usually from the older kids. Run across the yard with the Doberman. Ding Dong ditch Ed Dobierski, who was known to have a shotgun by the door. Sprint down the train trestle as the locomotive approached. Young George thrived on these and other challenges and spent most of his waking hours roaming the streets or playing in the park.
Villanueva couldn’t have gone home after school if he’d wanted to. His mother actually locked him out of the house until dinner. This prevented her rapidly growing son, whom she called Jorge until the day she died, from devouring all the food she was cooking. It also kept him from messing up her orderly house. Villanueva never imagined he’d live in the type of gargantuan home he and his now ex-wife purchased. Maybe that’s why he’d gone along with her. It was beyond his imagination—even if it was god-awful.
Villanueva turned his Jeep into the drive and pulled up to the front door. A thin film of sweat covered his face, and his head pounded from the previous night’s rum and Cokes at his favorite bar, O’Reilly’s. He had left alone, much to his chagrin, and he made a mental note that he needed to drop a few pounds. It was definitely hurting his mojo at the Irish pub. Villanueva had found the bar as his marriage was falling apart. It was close to the hospital, for one thing. Even more important, O’Reilly’s was small, dark, and unpretentious. There were no plants, and the decor consisted of plastic beer lights and other handouts from distributors, plus the odd knickknacks brought by customers. There were Michigan and Michigan State football helmets gathering dust on a shelf behind the bar. Assorted bumper stickers adorned the beer coolers below the bottles of hard alcohol. One read:
YOUR PROCTOLOGIST CALLED, HE FOUND YOUR HEAD
. And another:
MY MIND IS LIKE A STEEL TRAP: RUSTY AND ILLEGAL IN 37 STATES
. O’Reilly’s was the way a bar should be, in George’s view. It was the kind of place where the bartender didn’t blink if someone ordered a boilermaker and didn’t need to find a book to make a sidecar or some other cocktail from another era. Of course, George’s drink was simple enough, rum and Coke. He loved the Havana Club dark Cuban rum the best. Villanueva saw it as the perfect synergy of caffeine and alcohol. A little too perfect.
Toward the end of his marriage, Villanueva had come home so drunk a couple of times, he wasn’t sure which of the identical curving roads in the enormous, labyrinthine development was his own. They all had botanical names—Magnolia Lane, Azalea Circle, Ivy Trace—and he couldn’t read the signs in the dark in his inebriated condition anyway. They were all bracketed by nearly identical, imposing brick homes that screamed for all to see that the owners had “made it.” And they all ended in cul-de-sacs, with grassy round circles at the end for the children to play on if they ever got off the Nintendos or Xboxes or PlayStations and went outside.
Cul-de-sacs
. Even that got under Villanueva’s skin. “When I was growing up, we called ’em dead ends,” he would tell his ex when he wanted to get a rise out of her.