The Devil You Know

by Freida McFadden

  I’m not sure whether to answer as, “This is Dr. McGill.” It’s the hospital, after all. Then again, maybe it’s just Lisa calling me from work. I don’t want to sound like an idiot, so I just say, “Hello?”

  “Hello? Jane?”

  I frown. “Yes…”

  Leah chooses this moment to wander into the room holding her sippy cup. Yes, she’s four years old and still drinks from a sippy cup. If we don’t use a sippy cup, she spills whatever she’s drinking. At this rate, she’ll have the sippy cup till she’s eighteen. Well, at least she’s out of diapers.

  “Old McMommy had a farm!” she sings loudly, “E-I-E-I-O!”

  The voice on my phone says, “Hi, this is—”

  “And on that farm, there were some Mommies!” Leah continues. “E-I-E-I-OOOOOOOO!”

  I flash Ben a pained look. He gets the hint and herds Leah into the kitchen so I don’t have a soundtrack to my work conversation.

  “Sorry about that,” I murmur. “Who is this?”

  “Jane, this is Adam Wiseman in the neuro ICU.”

  Adam Wiseman. I worked with his wife during residency, and I’d been out with the two of them several times before my life became impossible. He’s the attending physician in the VA’s neuro ICU, and from what I can tell, a really good neurologist. “Hi, Adam,” I say. “What’s going on?”

  “Listen.” His voice lowers several notches. “I just thought you’d like to know that I’ve got your patient here.”

  “My patient?” I have no idea what he’s talking about.

  “I believe he’s a big frequent flyer with you, judging by the chart,” Adam says. “Herman Katz?”

  I feel like someone just punched me in the gut. Herman Katz. In the neuro ICU. That can’t be good. “What happened?”

  “He had his carotid endarterectomy yesterday,” Adam explained. “Then this morning, he became densely hemiparetic on his right side and globally aphasic. Then he became difficult to arouse.”

  Densely hemiparetic, meaning he can’t move his right arm or leg. Globally aphasic, meaning he can’t speak or understand language. Difficult to arouse, meaning they can’t wake him up.

  “He’s a little more alert now,” Adam continues in that same low voice. “We decided not to intubate him, but based on his head CT, he’s had a dense MCA stroke.”

  Great. I referred him for a surgery to prevent a stroke, but instead we managed to cause one.

  “Why are you whispering, Adam?” I ask him.

  He’s quiet for a moment, then he finally says, “You know that new surgeon, Dr. Reilly? Well, he did Katz’s surgery, and he specifically asked me not to call you.”

  I grip the phone tighter. “He did?”

  “Yeah.” Adam sighs. “And he’s such a dick that I didn’t want to argue with him about it. But I figured you’d probably want to know, considering Katz’s entire medical record is like a zillion notes from you.”

  “Right,” I mumble. “Yeah, you did the right thing. Thanks for telling me.”

  After I hang up with Adam, I feel numb. Ben starts rubbing my shoulder and asking me what’s wrong, but I don’t even know where to begin. After all, Ben doesn’t know about Ryan and I’m not going to open that can of worms.

  The thing is, whatever else was true, I’ve always thought of Ryan as a really great surgeon. Everyone knew how good he was. A lot of surgeons are arrogant for no reason, but he actually deserved to be arrogant. He was amazing at what he did.

  Except now I’m worried he nearly killed my patient.

  Chapter 30

  Ben agrees to take Leah to preschool the next morning so that I can get to work early and visit Herman Katz in the neuro ICU, a place I’ve always found eerily quiet and clinical. I’m glad to find Adam Wiseman at the nursing station, documenting at a computer. Adam is a slim guy with nerdy black glasses that accentuates his image as a brainy neurologist. He smiles grimly when he looks up and sees me standing before him.

  “Jane,” he says. “Thanks for coming by.”

  “How’s Mr. Katz doing?” I ask.

  Adam rises from his chair and stretches out his back. “Stable. We’ll probably transfer him to the floor soon.”

  “And by stable, you mean…?”

  He shakes his head. “His deficits haven’t improved at all.”

  I suck in a breath. “He’s got a daughter. Did you call her?”

  “Yeah, before I talked to you,” he says. “She’s got childcare issues, but she told me she was going to try to get a flight in.”

  I push away the sick feeling in my stomach. “Can I go see him?”

  Adam nods. “I think it might be good for him to see a familiar face.”

  Yeah. If he even recognizes me.

  “Adam,” I say softly. I glance around to make sure none of the nurses are nearby. “Can I ask you a weird question?”

  “Sure.” He frowns at me. “What’s up?”

  I hesitate. Just asking the question that’s been running through my mind would be potentially damning. But I have to know.

  “Do you think something went wrong during the surgery?” I ask. “I mean, do you think that… that maybe it wasn’t done properly?”

  I can see the answer all over Adam’s face. “I don’t know,” he quickly hedges. “I don’t really know Dr. Reilly. I’ve heard good things about him though. But of course, I can’t help but wonder…”

  We stand there staring at each other for a minute. Finally, Adam says, “Why do you ask, Jane?”

  “Just wondering,” I mumble.

  After all, I’ve kept Ryan’s secret for this long.

  Adam directs me down the hall to Mr. Katz’s room. The ICU smells like betadine, the odor permeating my nostrils and making me feel vaguely woozy. I steady myself and walk down to the third room on the left, the one with KATZ printed in magic market on a removable sign next to the door. I knock gently on the partially ajar door, but don’t hear a response.

  Okay, I’m going in.

  It’s funny because I had never realized that Mr. Katz was actually always in quite good shape for his age. Of course, seventy is the new sixty, but Mr. Katz just never looked like a man in his seventies. He looked sixty tops.

  Now he looks a hundred.

  I see him lying in the hospital bed, the oxygen nasal cannula prongs stuck up his nostrils. He seems tiny and shrunken. Tufts of white hair stick up off his pale, fragile scalp in every direction. He’s asleep in his bed, but his mouth is hanging open, revealing his dry tongue. He’s got the “O sign”—a mouth that hangs open in your sleep is not a good prognostic sign.

  See, Mr. Katz? There are worse things than cancer.

  “Mr. Katz?” I whisper.

  He doesn’t answer. For a moment, I’m scared he’s dead, although the monitors attached to his chest are recording a normal heart rate and rhythm. After a minute, his eyes flutter open. They’re brown and watery and bloodshot.

  I’d been scared that Mr. Katz would have absolutely no clue who I was. But I can see the recognition in his eyes, even if he can’t manage to say my name. He opens his mouth to speak but no sounds come out. He’s profoundly aphasic. His stroke knocked out all his language centers. They’ve destroyed one of the very things that makes him human.

  His right arm is propped up on a pillow, swollen and immobile. I walk closer to the bed and Mr. Katz holds out his left arm to me. I grasp his hand in my own—his feels cold and shriveled. I sit down at the side of his bed and watch as his eyes fill with tears.

  “You’re going to get better,” I promise. Even though I can’t really promise that. It doesn’t matter anyway—I don’t think he understands a word I’m saying.

  I hate this. I hate that this is my fault.

  Well, not only my fault.

  “Jane!”

  I turn my head and see Ryan standing at the door to Mr. Katz’s room, dressed in his green scrubs. He looks more rumpled than usual—instead of being clean-shaved, he has golden stubble on his chin and his hair
is disheveled. I wonder if he’s been here all night. I haven’t pulled an all-nighter since residency.

  “What are you doing here?” he hisses at me.

  I apologize to Mr. Katz and stand up to face Ryan. “This is my patient.”

  “No, he’s my patient.” Ryan glares at me. “How did you find out he was here? Wiseman told you, didn’t he?”

  I don’t say anything.

  “I knew it!” he growls. “I’m going to kill that arrogant prick. He should never have—”

  “Adam isn’t an arrogant prick,” I interrupt him. I can see that not only does Mr. Katz seem startled, but we’ve drawn the attention of several nurses, who probably overheard Ryan angrily badmouthing their attending physician. “Could we talk about this somewhere else? Please?”

  “Fine.” Ryan stalks away from me, and I rush after him down the hallway. Good to see that his temperament hasn’t changed at all.

  I follow him until we reach the call room just outside the ICU. The door to the tiny room is open, revealing a single bed and small wooden desk. The two of us have been in a lot of call rooms together in the past, but never to fight. But we’re not going to do that other thing again. That part of our relationship is over.

  “So why are you so angry that Adam told me about Mr. Katz?” I say to Ryan, once we’re in the privacy of the call room.

  “It’s not your concern,” he says. “He and I are managing the patient. No offense, Jane, but you’re just his primary care doctor.”

  Gee, thanks.

  “But I knew him really well,” I say. I consider sitting on the bed, but I can tell Ryan wants to stand. He never sits—it’s a surgeon thing. “I had a right to know. Don’t you think so?”

  Ryan runs a hand through his already messy hair. His hair is so light in color that I somehow hadn’t realized quite how much gray was threaded through it until this very moment. “When Wiseman told you about it, did you ask him if I screwed up?”

  “What?”

  He inspects my face. “You did, didn’t you? That’s the first thing you asked him. You said, ‘Did Dr. Reilly fuck up the surgery?’ Admit it.”

  I bite my lip. “Well, it’s only natural to wonder…”

  “Stroke is a known complication of carotid endarterectomy,” he practically spits at me. “It’s a risky surgery and your patient knew the risks. It went fine—perfectly. Then he stroked out. You think I know why?”

  I shake my head. “I wasn’t blaming you…”

  “The hell you weren’t!” Red rushes into Ryan’s cheeks—damn, he’s pissed off. “You thought that because I’m sick, I shouldn’t be operating anymore. That’s what you were thinking.”

  I want to tell him he’s wrong, but he’ll know I’m lying. That’s exactly what I was thinking.

  He shakes his head at me. “If I thought my… condition was any danger to my patients, I’d stop operating. Immediately. I mean, I will… when…”

  He seems to deflate somewhat. He sinks down onto the bed, and stares down at his hands. I sit down next to him, but I’m not sure what to say. I can’t tell him everything is going to be okay. It isn’t. It definitely isn’t, and he knows it.

  “Jane, you have to believe me,” he says, “if I ever feel like I can’t operate anymore at a hundred percent, I’ll stop. I would never, ever jeopardize my patients.”

  “I believe you,” I murmur.

  “They’ve got plenty of administrative and research work for me to do,” he says. “Don’t worry.”

  We had a conversation just like this when I first found out that he had Huntington’s. He reassured me that he’d do paperwork when he couldn’t operate. And after that…

  I’ve got a gun locked away in my desk drawer at home.

  I don’t want to think about that. I don’t know if he was serious or not, and he’s got a lot of time left before he reaches that point. I’m sure he’ll change his mind. I’m encouraged that he doesn’t say it now.

  Ryan lets out a long sigh. “It sucks about Mr. Katz.”

  I nod. “Yeah.”

  We sit there for a minute until Ryan’s phone goes off. I notice that his hand jerks slightly as he attempts to pull it out of his pocket, but I don’t say anything. I’m sure he already knows what I’m thinking.

  Chapter 31

  The last name on my list of patients for the morning is Matthew Stoughton. It doesn’t immediately ring a bell, but right off, I assume that he’s on the younger side based on his first name. There are exceptions, but old men are usually not named Matthew. They’re more likely to be named Robert, Richard, or Charles.

  Given a patient’s first name, I can often guess their age within a decade. Especially with women, since female names tend to be trendier (although I haven’t gotten to see many female patients since I’ve been at the VA). For example, if you meet a woman named Dorothy, Helen, or Ruth, she is definitely older than the hills. You are never going to see a twenty-year-old woman named Mildred or Agnes. That just doesn’t happen.

  Or if the woman’s name is Linda, Donna, or Nancy, she’s probably middle-aged. A woman named Jessica, Nicole, or Melissa is probably more likely to be around my age. And if you meet a girl named Sophia, Emma, or Isabella, she’s probably in Leah’s preschool. It’s harder with men, but you can bet a guy named Matthew, Justin, or Brandon will be an OEF/OIF vet, while a Frank or a Walter probably fought in the Korean War or even maybe World War II.

  So when you give your kid a trendy name, beware. When you name your daughter Madison in 2010, remember that her name will be the Mildred of 2090.

  When I glance through his chart, I discover I’m right about Matthew Stoughton. He’s thirty-three years old and no longer active duty, which is a good thing because at our last visit, I discovered that he was snorting coke. He didn’t come to me because he was snorting coke though. He came to me because he was having chest pain. Probably because he was snorting coke. I gave him a whole speech about it last time he was here.

  Of course, Mr. Stoughton’s real problem is probably his PTSD. He’s had a hard time adjusting since he got home from Iraq, and he’s struggled with outbursts of anger and bad nightmares. Aside from the coke, he drinks and God knows what else. He’s enrolled in an outpatient support group for vets with PTSD but he rarely shows up for the groups—same deal with his one-on-one appointments. Every time I’ve seen him, he’s had dark circles under his haunted eyes.

  But today he looks great. He flashes me a big smile when I pick him up in the waiting room. He’s even put back on a little weight, so that I can better identify the tattoos wrapping around his arms: dog tags, an American flag, and two rifles intertwined.

  “How are you doing?” I ask him once we’re in the examining room.

  “I’m good!” Mr. Stoughton’s eyes are bright. “My chest pain is gone!”

  “That’s wonderful!” I exclaim. “Why do you think that is?”

  “Probably because I quit snorting coke,” he says, like I’m an idiot.

  “Right. That would do it.” I smile at him. “Did our visit motivate you?”

  I’m hoping he’ll tell me that the talk I gave him at our last appointment was what turned his whole life around. But instead, he laughs. “Well, a little. But really, it was April.”

  April—my age or younger. See how good I am at this game?

  “Who’s April?”

  “My girlfriend,” Mr. Stoughton says. “Let me tell you, she lays down the line. I mean, not literally, obviously—she won’t let me do coke at all.”

  “Well, that’s great,” I say.

  He nods. “Also, she’s got the two of us going to the gym every day. And she cooks every night—we’re on an all-Vegan, gluten-free diet.”

  “Oh, that sounds…” Disgusting. “Wonderful.”

  “Also, I got rid of my motorcycle,” he says. “April got me a bicycle and I ride everywhere on it. It’s great exercise.”

  “Wow.”

  “We’re basically ridding our bodies entirely
of toxins,” he explains. “Like, instead of coffee in the morning, we have a mixture of wheat grass, kale, broccoli, lemon juice, and green tea.”

  “Oh.” I can’t even pretend to find that appetizing.

  “Also,” he adds, “April threw out our television.”

  I nearly gasp this time. It sounds too horrible for words. “That’s great.”

  “Yeah,” he says, although he doesn’t sound as convinced this time. He thinks for a second, “Dr. McGill, do you ever call family members of patients?”

  I nod. “Sometimes. Who would you like me to call, Mr. Stoughton?”

  He takes a deep breath. “April. Maybe you could tell her that it’s okay for me to have a cheeseburger sometimes. And that it’s okay to have a cup of coffee.”

  “I could do that,” I say, even though I’d rather lick the floor. This April sounds like a tough cookie.

  “Also,” he says, “maybe you could tell her it’s okay for me to have some coke? I mean, just a tiny bit.”

  I almost laugh. What kind of person asks their doctor to tell their girlfriend that it’s okay to snort coke? I must really seem like a pushover. “I don’t think April will go for that.”

  “No,” he agrees. “Probably not.”

  After I finish up with Matthew Stoughton, I go onto the computer and look up the record on Herman Katz. He’s still hospitalized, thanks to a bout of right lower lobe pneumonia. On top of everything else, his swallowing has been affected by the stroke and he’s been aspirating. I see a note from interventional radiology, who recently inserted a feeding tube into his belly. I close my eyes and remember Mr. Katz showing me his “I’m a little teapot” position to explain when he felt pain. A guy like that is not going to do well with a feeding tube.

  And part of me still blames Ryan. Despite what he claimed. I scoured the operative report he dictated for any signs that something went amiss, but I’m not sure what I’d find there. Then while the incision was being closed with #3-0 Vicryl, my hand jerked wildly and caused a massive stroke.

  “Dr. McGill!”

  I look up and see Dr. Kirschstein at the door to the examining room. He’s hovering at the door to the examining room, wearing his white coat. His eyes are unreadable thanks to his eyebangs.