Brains

  ◆◆◆

  By the time Cathy had finished with her hair, it was about one o'clock. Her phone showed a text. “All done. Going home, will take nap. Wake me.” She stopped by that French bakery that he liked on the way, and brought him one of their twice-baked almond croissants.

  Jack was most definitely sleeping when she got home. On the living room couch. She looked at him for a minute. She tiptoed over and knelt down next to him. She put her lips to his ear and purred softly, “Hungry, baby?” He turned his head to her, and kissed her mouth deeply.

  “Mmmmm.” He took a deep breath. His eyes popped open and he sniffed, then grabbed the croissant that she was holding over him. “Thanks, sweetie.”

  “How's your patient?”

  That was actually a complex question. Jack was not really sure of the answer. He decided to go with the short version. “Seems okay. Woke up fine.”

  She had her own mission. “You okay for the flea market?”

  Jack and Cathy were just getting ready to head out when the doorbell rang. He opened the door to find a bicycle messenger with a slim ivory envelope.

  “John Xavier Tucker, MD?”

  “Yes. What's this?”

  “No idea. Don't shoot the messenger.” He grinned. “Sign here.” Jack signed, and he was back on his bike and gone.

  Jack examined the envelope. The return address had about nine names and covered a ridiculous percentage of the available space. Attorneys. He turned back into the house and tore it open.

  The salutation indicated that copies of this had been sent via certified mail and messenger, and listed the Lenox Hill Hospital CEO, Paul Franz, Edward Douglas, Sunny Patel, three intensivists, and “any and all persons involved in the care and treatment of Augustus Overbridge on October 21 and 22” as co-recipients.

  “What the HELL is this?!” Cathy came around the corner. She had not heard him swear previously. It was almost a joke with them.

  He read on.

  “By the hereby, you are served notice that under no circumstances may the private health information of Augustus Overbridge be shared with anyone not directly involved with his care. This specifically and particularly includes administration and staff at Our Lady of Salubrious Penitence. Any violation will be met with a complaint to the New York State Board of Medical Licensure, and will be referred to the New York Prosecuting Attorney for investigation of violation of privacy provisions of the Health Insurance Portability and Accountability Act of 1996.”

  Jack looked up at Cathy. “I guess that, since I read that to you, I'll be going to prison.”

  “What's he worried about? You said he was fine.”

  “Well, he was fine. I didn't give you the whole story. We extubated him, and then he immediately demanded to be discharged, and left Against Medical Advice. Oh, and he invited us to dinner on Friday at seven.”

  “You should probably call your attorney.”

  Jack put in a call to LexMed's main attorney, got an answering service, this being Saturday, and left a message for an urgent call. He then went to the den and scanned the letter, emailed it to the attorney, and cc'd himself so it would be available on his iPhone.

  “Okay, let's go.”

  “What? Where?”

  “The flea market. We're losing daylight here.”

  “Shouldn't you wait for your attorney to call?” Cathy continued to be baffled by his ability to compartmentalize. Jack was the epitome of the mission-driven, single-focus male.

  “My phone works all over the city. No reason to sit around here.”

  So, off they went across the park. It was cold, but sunny, and they walked briskly. Jack was quiet, just enjoying the fall air. Cathy was agitated, and after a couple of blocks she demanded, “Jack, what can you tell me about this Dr. Overbridge? You said it was like getting a call that God was in the emergency room. Do you know him? You've never mentioned him before.”

  “It's kind of a long story.”

  “It's a long walk. This whole legal thing worries me. Please?”

  Jack sighed. “Okay, when I started my residency at the New York Neurological Institute in June of '92, Dr. Overbridge was one of the attending surgeons. He had been there for, I don't know, seven or eight years. A real superstar, almost a force of nature. His reputation as a surgeon and teacher was one of the main things that had me choose that program. He seemed to operate day and night, had an aggressive research program, wrote dozens of papers, and his talks were always the biggest draw at the big international meetings. Plus, he was cool.”

  “Cool?”

  “Yeah, tall, ripped, thick black hair in a shiny pony-tail, did triathalons. He rode a Ducati from his SoHo loft up to the Columbia Presbyterian campus on 168th street, rain or shine. You would see his picture with some model in the NY Times living section about every month.

  “Ducati?”

  “Italian motorcycle. Think a two-wheeled Ferrari.” He laughed. “There was this one story about him actually in the New Yorker. One night, he heard a noise in his apartment, so he grabbed this antique cross-bow he had hanging on his wall and went out to investigate. He found a burglar dumping his rare coin collection into a pillowcase. Overbridge flipped on the light and invited the burglar to assume the position. The thief started to walk towards the door, laughing and saying that no one wearing a night shirt would have the nerve to shoot.

  “'You don’t understand,' Overbridge replied, 'I am a neurosurgeon. These hands kill people every day. I would be delighted to add you to the list. Delighted.' The burglar assumed the position. He was delighted to await the arrival of the police. Delighted.” Jack was shaking his head, laughing again.

  “That was crap, of course. He was an incredible surgeon. Hardly ever had complications, much less fatalities. He was incredibly intuitive and insightful, and operated with a speed and confidence that was breathtaking. One glance at an angiogram and he would plan an attack. That's what he called it. An attack. Aneurysms were his specialty, he loved the implicit danger of the ticking time bomb, the elegant resolution with a clip. Seriously, he could immediately operate and get to areas that other surgeons would have to spend days planning and contemplating.”

  Jack stopped and looked at Cathy. “So, you know about Alexander Lake?”

  “Yes Jack, I work for the Lake Foundation.”

  “Do you know how he died?”

  Cathy tipped her head. “Some sort of a brain thing, long time ago.”

  “December, 1994. We got a call that Alexander Lake was on his way from Paris. He was only forty-five, and I can't remember whether he was seventh or eighth on the Forbes' richest list, but a mega-billionaire. He still ran his tech empire, but had already started pouring most of his personal wealth into the Lake Foundation, and had just won the Nobel Peace Prize for his work in third-world health. And, he had an aneurysm. Developed headaches, and the French worked him up with scans and an angiogram. He wanted the best, and that was Overbridge, so he grabbed his X-rays and hopped on his private jet for New York. He demanded surgery instantly, and was in the operating room a few hours after landing.

  “I was the junior resident in the OR that day. Dr. Overbridge walked in, stuck his favorite Led Zeppelin tape in the boom box, and went to look at the angiograms which had been placed on the large twenty-panel view box by Jeff, the senior resident. He looked at them, spotted the aneurysm instantly, told Lake it was a 'chip shot', and gave the anesthesiologist the 'get going' sign.

  “Once the patient was asleep, Dr. Overbridge marked the incision, which I made, then Jeff cut out the square of skull and we began to retract the brain. Soon Overbridge got down to the offending vessel. It was normal. He looked at it for a minute, then went over to the view box and stared. After a few minutes he saw the problem. Jeff had put the films up backwards, not understanding that the French protocol was the opposite of the U.S. protocol, and not having known enough French to read the labels 'droit' and 'gauche'.

  “We were operating on the wrong side of the
brain.

  “He screamed, and started in on the other side. We had to re-prep, re-drape, new incision, and go back into the opposite side of the skull, which took over an hour.

  “During that hour, Mr. Lake's leaking aneurysm had become a burst aneurysm. He died right there on the table.”

  Jack had stopped walking, and just stood there.

  “How horrible. I can see why you haven't talked about it before. What happened next?”

  “Well, Overbridge picked up a stool and threw it through the view box, and threatened to kill Jeff, then just left. It was in all the papers, and Overbridge was completely different after that.”

  “Did they sue him? Or fire him?”

  “No, they fired Jeff, and he got most of the blame, but that didn't really change it for Overbridge. He took to this weird over-meticulous planning, limited his operating schedule to one per day, and spent hour after hour reviewing his plans. It was ironic, given that he never changed them – he always knew the right plan from the start. He would come into the OR stating the number of steps planned, and insisted that the circulating nurse check them off as they were completed. And I mean detailed steps.

  “'Patient brought to room. Check off number one.'

  “'Films placed on viewbox. Check off number two.'

  “'Orientation of films and name on films verified by me. Check off number three.'

  “'Orientation of films and name on films verified by resident. Check off number four.'

  “And so on. By the time we would get to the actual skin incision, usually at around step number seventeen, nearly everyone in the room would be close to psychotic.

  “Interestingly, once the operations started, they proceeded at his usual speed, and he showed the same brilliant flair as before. He continued to have the best results of any aneurysm surgeon in the country.

  “His cool-ness was also gone. His long hair fell out over about three months, he stopped riding his motorcycle, and actually had a car service bring him to work. No more models. No more social anything. No more lecture trips around the world. No more research, no more papers. No more music in the operating room. Nothing but the surgery itself.

  “Before Lake, he was our favorite attending. He had parties at his loft, told us stories from his time at Berkeley in the '60s and literal war stories from Vietnam. After, although I operated with him dozens of times more, we never had another single conversation that was not directly related to the case at hand.

  “A few months after Lake's death, Overbridge suddenly left town. He came back a month later, walked into the Chairman's office and announced he was leaving to take a position at Our Lady of Salubrious Penitence in East Harlem. Dr. Knox about had a stroke. 'Owl's Pee!?' he bellowed. 'Have you lost your mind? You could be the next Chairman HERE!' But he left. I had not seen him again until Friday night. He became an eccentric recluse. A recluse who still does more aneurysms, more successfully, than anyone on earth.”

  They walked in silence the rest of the way to the Flea Market. Just as they got there, Jack's phone buzzed. It was the attorney. “Go on in. I'll track you down after I talk to Vern.” Cathy acted like she wanted to wait with him, but he shooed her away. He sat down on a bench.

  “What's up, Jack? More HR crap from LexMed?” Jack was president of the large multi-specialty group, and spent a lot of time talking to the attorneys about personnel.

  Jack briefly explained the case, and asked him if he had seen the email. He had not, but said he would take a look and get back to him.

  Jack texted Cathy, and went into the flea market, where she was examining some truly ratty tapestries that looked like junk to Jack.

  “Wouldn't these look great in the entryway?”

  He was always honest, so he said “No.”

  She laughed. “Oh, good. I was afraid you wouldn't be paying attention. The attorney must not have had anything for you yet.”

  “No, just getting started.”

  They wandered the market for over an hour. He had developed an uncontrollable urge to buy her some earrings, and they eventually found a simple silver loop pair that looked lovely. As they were walking home, Vern Critchlow called back.

  “Well, it’s pretty straightforward. Just don't say anything to anyone.”

  “I'm worried he's going to try to go to work on Monday. It doesn't seem like that would be safe, for him or for his patients.”

  “Let me think about that. I'll shoot you an email later. In the meantime, at least you have the weekend off. Unlike me.”

  “What a martyr. I have no sympathy whatsoever. As a matter of fact, it's fun making attorneys actually work on off hours.”

  “Well, it will be great fun billing you my weekend rate.” He laughed and hung up.

  When they got home, Jack went to the den and pulled up the email from Vern.

  Dear Jack-

  The HIPPA regulations clearly protect your patient from any disclosure, UNLESS you can document a threat to health or safety. Here is the relevant passage:

  Serious Threat to Health or Safety. Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

  So, if you can reasonably claim you thought there was a threat, then you could tell whoever was necessary to stop the threat. I would recommend that you document the threat, and you will certainly need to be able to defend your assessment.

  I would recommend that you try and have a conversation with your patient to see what his intentions are. Maybe he has some other reason to want to keep things quiet, like a family money issue or something.

  I'm available by email this weekend, and you can call me Monday on my cell anytime after six a.m.

  Best,

  Vern

  Jack called Dr. Overbridge's number. He got a recording.

  “This is Augustus Overbridge. It is Saturday, October 22, 2016, and I am resting at home. I am in good health and don't need anything. Thank you for calling.”

  “What're you going to do?” asked Cathy.

  “I'll call tomorrow. He has to understand I will be trying to check on him. Plus, I need to confirm for dinner on Friday. If you are willing to go.”

  “Are you kidding? I wouldn't miss it.”

  Chapter 19

  Sunday, October 23

  Dominican Republic

  Santiago touched Alyssa's shoulder gently to awaken her, and was rewarded by a lightning fist to the groin that left him gasping on the floor. “Sorry,” she grinned, “you startled me.”

  His first impulse was to throttle her, but he had seen her work before, and was not completely confident that he would succeed.

  He considered their relationship complicated. She did not. They HAD no relationship, in her view, and she made it crystal clear that, although their roles sometimes led to expressions of feigned affection in public, in private, she wanted nothing to do with him. He was allowed to look, but not touch. The reason he thought it was complicated was that she gave him so MANY opportunities to look, and the passion in their kisses, played always for the benefit of their marks, was just too real.

  “Let’s review again,” she demanded, sitting up in bed, the sheet barely clinging to her nipples.

  Santiago licked his dry lips. “Okay. I sat next to them at the Fiesta, and told them my lovely wife had been detained by work in Monterrey, and that we would meet them for a late breakfast. Here are my notes on everything they talked about for the past two days. I’m sure you have enough to become her best friend.”

  “The plane is set for this afternoon, right. No screw-ups?”

  “It’s set. The kid is practically jumping up and down with excitement. He’s never been in a small plane, and can’t wait for the tour.”

  Alyssa rolled out of bed, completely naked, skipped past Santiago, and jumped in the shower. She e
merged a few minutes later in a bright pink micro bikini with a diaphanous cover that did nothing to disguise her curvy figure. Santiago was having none of that. “We need Marta to want to be with us, not be worried about Miguel staring at your boobs.”

  She stuck out her tongue and put on a striped t-shirt and some shorts. They headed down to pool side, where Marta was busily videoing Jorge as he played with the other children in the pool.

  “Holá, Marta,” Santiago called. Introductions were made, and after a few minutes Alyssa and Marta had discovered that they had an amazing amount in common, such as Alyssa's fondness for Picasso's “Blue Period” and films by Almodóvar, particularly “Women on the Verge of a Nervous Breakdown.”

  Through it all, Marta continued to take videos. Alyssa was interested. “My sister takes lots of pictures of her daughter. She is always complaining that she doesn't have enough memory on her phone for all of the things she wants to save.”

  Marta laughed, “No problem here. I have mine set to upload to Google Drive every night.”

  “Really? That sounds great. Can you show me how it works? I’d love to show my sister.” She pulled out her iPad and handed it to Marta.

  Marta obligingly logged on and pulled up the link. “It's a little disorganized,” she laughed, “but I must have a thousand hours of video.” She then showed Alyssa how she started the upload from her phone. It was quick and the morning's cache was done in under ten minutes.

  After lunch, they all hopped into a minivan cab to the harbor, where a Cessna 208 Caravan float plane was waiting for them, a large sign on the fuselage reading “Excursiónes: Costa del Sur.” They climbed on board, and soon were flying east along the southern coast of Hispaniola, the views breathtaking. Santiago served champagne to Miguel and Marta, and Fanta orange soda to Jorge, all of whom were in a drug-induced sleep within minutes. Four hours and eight hundred miles to the north, they landed in a secluded bay on Walker's Cay, where they refueled and simply dumped Miguel into the sea, his ankle handcuffed to a kettle bell. They also took the time to peel off the “Excursiónes: Costa del Sur” signs, and changed the call letters on the tail. Marta and Jorge were given injections to keep them asleep, and they immediately took off again, making the thousand mile trip to Sayville, Long Island, in another five hours, arriving just after two a.m. Santiago and the pilot carried the still-unconscious Marta and Jorge to a waiting van. Alyssa returned to the plane, which refueled and took off. Santiago had no idea where she was headed, and knew better than to ask.