“I think long distance would have been really hard,” she said honestly.
“Yeah, me too. So what’s with this new guy? Tell me about him.” Andy was always interested in her life, when he had time.
“Handsome. Older. Movie producer. Nice.”
“Serious?”
“No.”
“Slept with him?”
“Not yet, doctor. You sound like my gynecologist.” Andy laughed at that.
“Wait till I get assigned to OB/GYN. We can talk about it then. My mom wants me to be an OB and go into practice with her. I don’t think so. So how much older is he?”
“Not that much. He’s thirty-nine.” She knew Nancy was a year older than Andy, but in the same year of medical school. She had taken a gap year to travel before starting. But one year made no difference—sixteen years would.
“That’s old for you, don’t you think?”
“Maybe. It feels kind of grown-up and sophisticated. It’s fun for now.”
“I guess, with the opening of the ballet and all that. It’s a far cry from my life at the moment. The best we can do is McDonald’s, between studying, classes, and rounds at the hospital with our professors, and I fall asleep at the table.” She suspected that he made it sound worse than it was, but she could tell he was stressed, and he had no idea when he was coming home for a visit. “Well, let me know how it’s going. It’s nice to remember how the other half lives, people who actually get to go out to dinner, sleep, and even get laid. I’ll be too old to do it by the time this is over.”
“I don’t think so, Andy. I think you might still be okay.”
“Don’t bet on it,” he said ruefully. “Take care, and call me sometime. I love you, Iz. Don’t forget that.”
“I never do. I love you too.”
“Yeah, I know.” It was good to hear, for both of them. They hung up a few minutes later. Izzie decided to clean her apartment, and Andy went back to work. He had an exam the next day.
It was a nasty January day in Boston, and everyone had the flu, and the post-holiday doldrums. There was some kind of virus going around, and half the kids in the hospital were ones they’d admitted for dehydration after days of throwing up. Andy thought if he saw another vomiting three-year-old, he’d scream. There wasn’t much they could do for them except give them fluids. And there were some nasty chest infections that had turned into bronchitis and then pneumonia. They had admitted a few of those cases too.
He ran all day, as a second-year student working with the interns and chief resident that day, who was a nasty guy dedicated to making his life miserable, and Andy had a mountain of forms to fill out. Nancy was finally off duty after three days working in the ER, and she was home sleeping. Andy had been up for thirty-six hours, after studying late and working.
He was still relatively fresh at nine o’clock that night, after an eight-hour work day, when a nine-year-old girl came up from the ER, with what they thought was flu and a high fever. She had a hundred-and-four-point-five temperature, and she didn’t look good. The resident had seen her and told Andy and the nurses to get her hydrated and give her something to bring the fever down. She was crying and said she felt awful. She looked it. But since it was presumably only flu, they let Andy take her intake history. Her mother had three other kids in the waiting room with her. The child’s father was out of town, and their pediatrician was away for the weekend and had only left an on-call nurse to check in with. The nurse had told the mom over the phone to go to the ER. The fever had only come on that day, at noon. But even after they put an IV of fluids into her, the fever continued to get higher and she got worse. Andy knew enough from his studies to worry about the possibility of febrile seizures and called the resident back in at ten.
“I don’t like the way she looks,” Andy said calmly, trying to seem wiser than just a second-year student. The resident checked her again and agreed that he didn’t like it either, and she was complaining of a stiff neck between sobs. “What do you think?” he asked the resident.
“Same as I thought when she came in,” he said, sounding impatient. “Bad case of flu. Let’s hope the fever breaks tonight.” They were doing all they could. He left Andy then, to take care of a six-month-old he had to intubate, with a heart problem. It was a busy night for them. Later when Andy looked in on her, the child’s eyes rolled back in her head while he examined her, and she lost consciousness. He hit a button on the wall, and instantly a team of nurses and doctors came in at full speed and began working on her, as Andy stepped aside, feeling helpless and inept. The chief resident, who had come from another floor, looked at Andy with a grim expression.
“Looks like meningitis. Did you suspect that earlier?” It was more of an academic question, but Andy felt it instantly as a reproach of his competence. And Andy actually had thought of it, with the stiff neck as a symptom, but didn’t want to sound like an alarmist or second-guess the resident on the case.
“I did … but I figured it probably was just flu.”
“It doesn’t make any difference,” he said tersely to educate him. “We don’t treat it any differently than what you and the nurses have been doing. We can get a tap on her now to confirm it,” he said, and ordered a nurse to call for a spinal tap. The child was still unconscious, and her body was blazing.
The team came in a few minutes later and performed a spinal tap on her, and as soon as they finished, her breathing became labored, and they intubated her, while Andy watched. They were doing all they could, and were breathing for her, as her blood pressure started plummeting and her heart stopped. Andy watched in horror as they performed CPR on her, then put paddles on her chest to defibrillate her and get her heart going again. The team worked on her frantically for half an hour. Andy felt tears roll down his cheeks, as he observed helplessly. Then the chief resident turned to him and shook his head.
“It was meningitis,” he said, as though that said everything.
“How do you know?” Andy asked, choking on a sob. He felt guilty and responsible for not saving her, but the others couldn’t do it either.
“Because she’s dead,” the chief resident said. She had lived only twelve hours after the onset of the fever, which was typical in severe cases. “Nothing moves faster than that. It can kill a kid with the speed of lightning, and adults sometimes too.” They had put a sheet over her after they took all the tubes out, while Andy stared at the little girl they hadn’t been able to save, and now they had to tell her mother. Or the chief resident did, and he motioned to Andy to come with him. Delivering bad news was part of the learning process. Andy followed him into the waiting room, while her mother was trying to deal with her three other children, who were seriously at risk now. The mother looked terrified when the two men walked in. All Andy could think of was that it was the worst moment of his life. He had to watch the resident tell this woman that her child had just died. He couldn’t imagine anything worse than what had just happened, and telling the little girl’s mother.
The chief resident told her, professionally and quickly, as gently as he could, that her daughter had meningitis and that there had been nothing they could do to save her. He said it was a dread disease and lethal in many cases in young children, and even if she had brought her daughter in earlier, it would have made no difference. She had been affected too severely by the disease. He said she could have contracted it anywhere, at school, in a shopping mall, on a bus from a total stranger. And no one was to blame. The chief resident examined the other children while she sobbed hysterically, and then she turned to Andy with a look of fury and beat on his chest with her fists.
“Why didn’t you tell me she was going to die? I would have been in the room with her! She died alone because of you! I’m her mother.” Andy wanted to die on the spot as she said it, and he apologized and said they hadn’t known, it had only become obvious to them in the last few minutes of her daughter’s life, and she had been unconscious.
The mother was inconsolable, and they ca
lled a friend to drive her home. The other children were fine for the moment, and it was possible they wouldn’t get it. Meningitis was entirely unpredictable as to who caught it, whatever the exposure. They left at two in the morning, after the attending resident and the chief had signed the forms and the death certificate. The child was taken to the morgue until arrangements could be made the next day. And as soon as it was over and the mother had left, Andy stood in a small supply room by himself, sobbing. The chief resident was looking for him and found him. He looked Andy dead in the eye and grabbed both of his shoulders in firm hands.
“Listen to me, we couldn’t save her. Nothing you did was wrong. You didn’t know what you were seeing, and even if you did, you couldn’t change it. I thought she had flu too. And even if I had diagnosed her with meningitis the second she came in, she’d still be dead now. Too often, you can’t beat meningitis, particularly in a child that age. She would have died no matter what we did.” He was almost shouting at him. It was the first child Andy had seen die, and he could still feel the distraught mother’s fists beating on his chest, accusing him. “I want you to go home now, and get some sleep.”
“I’m okay,” Andy said, sounding desperate and convincing neither of them. He felt as though he had failed abysmally. And he was convinced he had killed her by not recognizing the signs of meningitis himself. He didn’t believe a word the chief resident said—he thought he was just protecting him and trying to make him feel better.
“I want you to get out of here and get some rest,” he said firmly. “We all lose patients. It happens. Sometimes you just can’t win. We’re not fixing cars. We’re treating people. Go home, Weston. Come back when you wake up tomorrow. You need the sleep.” It was true, but he didn’t want to leave now. He had never felt worse in his life. He took off his white coat, and left the stethoscope on the shelf where they kept them, and he called Nancy on his way home. He needed to hear her voice, but she sounded busy when he called. He thought she had been at home, sleeping.
“Where are you?” he asked, confused.
“They had some kind of gang shooting at the fish market. They have four gunshot wounds here. They called me in to help. Where are you?”
“I’m on my way home. I was hoping you’d be there.”
“Something wrong? I thought you were staying late today.” She was confused too. They were both exhausted, and he was nearly hysterical with guilt and grief.
“They gave me a break,” he said vaguely. He didn’t add because I killed a child, but he wanted to. He didn’t have the heart to tell her. It was too awful. Nancy hadn’t lost a patient yet, and until tonight neither had he.
“I’ll see you later. I have to go back to work. Two of these guys are coding.” He knew that meant “code blue,” and they were in extremis. She hung up before he could answer. He hoped Nancy would be luckier than he was.
The little girl had coded that night, and they couldn’t save her. Her name was Amy. He knew he would remember it forever—and her mother hitting him in grief and fury.
The bed was unmade when he walked in. He could tell that Nancy had left in a hurry. The apartment was a mess because neither of them had been home long enough to clean it in weeks. There was a half-eaten pizza in a box in the fridge, which had been Nancy’s dinner, and it could have been his too, but he didn’t want it. He went to the bathroom to wash his face and stared at himself in the mirror. What he saw there was a killer, a man who wanted to be a physician and had already failed, a fraud, someone he hated as he looked at him. He always tried to do everything right in his life, for his parents, for Nancy, for his friends, and hoped to for his patients one day. Always the right thing. Until now. He had killed Amy. He knew he would never forgive himself for what had happened that night. He couldn’t be a doctor now. He wasn’t a healer, he was a murderer. The Hippocratic oath said to “do no harm,” and he had. He had killed her, by not knowing what she had, and by not saving her. He walked out of the bathroom with dead eyes. His BlackBerry was ringing, and he didn’t answer it. Nancy had just heard what happened, from one of the residents, and she was calling to comfort him. But he didn’t look at the phone in his pocket, and he wouldn’t have answered it anyway.
There were beams across the ceiling of the apartment they had rented. It looked like a Swiss chalet with a big stone fireplace, overstuffed couches, and the snow outside. He got a rope out of the supply closet they kept, put a chair under one of the beams, tied the rope to it, and made a noose, just like they had taught him in Cub Scouts. He got on the chair, put the noose around his neck, and jumped off, all within seconds. It was over just as fast as he had done it. It was all he could do now. He owed it to Amy and her mother. Her death had been avenged. And the BlackBerry kept ringing long after he was dead.
Chapter 22
Andy’s funeral was a major event. Important people were there—senators, congressmen, doctors, publishers. People stood on line to get into the church. And Izzie was there, the only one of Andy’s friends. She sat in the back of the church with Jennifer and her father. The parents of all her friends were there, and each of them had lost a child now. Nancy was sitting in the front pew with Andy’s mother, crying inconsolably. Helen kept an arm around her shoulders and cried too. Nancy was the daughter-in-law she would never have now. Andy had been twenty-three when he died, almost exactly five years after Gabby, and a year after Billy.
When Andy’s father came forward to give the eulogy, his first words were not about Andy, but about himself. No one was surprised.
“I never thought that this could happen to me, to us,” he said, glancing at Helen. “Losing a child was something that happened to other people, not to me. But it just did.” And as he said it, he started to cry, and finally became human. He stood there and sobbed for a long time, and then he talked about what a star Andy had been, in every way. Star son, star student, star athlete, star friend. No one would have disagreed. Izzie felt a knife pierce her heart as he said it. “And he would have been a terrific doctor too,” he assured everyone. “A child died, whom he couldn’t have saved, but he didn’t believe it. She had meningitis. So Andy gave his life in exchange for hers. To atone for what he believed were his sins,” he explained to everyone, but no one cared.
All they knew was that a wonderful boy had died. He had taken his life, and they would never see him again. It was the cruelest of destiny’s tricks, the death of a young person. The death of a child—worse, an only child. Izzie thought her heart would explode in a million pieces, and her head along with it. She couldn’t even think. She sat between her father and Jennifer and felt as though her life were over. She couldn’t even tell Sean because no one knew where he was. She hated him for being unreachable and for what he was doing. And when it was all over, she stood on the cathedral steps and watched the casket being put into the hearse. She had seen it too often. She didn’t even go to the Westons’ house afterward, she just couldn’t. She didn’t want to see anyone, not even the Westons, especially not the Westons, with their shock and grief. Her father wanted her to come home with them, but she wouldn’t. She wanted to go back to her apartment and be alone. Jeff and Jennifer left her there reluctantly, terrified that it would be too much for her, that she was at risk now too. But she insisted that she wasn’t and reassured them.
She sat in her apartment alone that night, going through old photographs, and stared at one of Andy. He had been such a beautiful kid, and a great friend. She had talked to him on the morning of the day he did it, and they had told each other they loved each other. They always did.
When the phone rang that night, it was Tony. He wanted to invite her to dinner. He had no idea what had happened. He had seen the item on the front page of the paper, but he had had no way of knowing that the boy who had committed suicide, from a prominent family of physicians, had been her best friend.
“How about dinner tomorrow night?” he asked her, pleased to hear her voice. She sounded a little strange, and he wondered if he had woken
her up. She said he hadn’t.
“I can’t,” she said in a dead voice.
“What about Tuesday? Wednesday I have to go to L.A., but I’ll be back on Friday, if you like that better.” He was anxious to see her.
“I can’t. My best friend just died. I think I’m going away.” She hadn’t thought of it before, but she liked the idea. Maybe forever.
“I’m so sorry. What happened?”
“He killed himself.” She didn’t offer the details, and then he understood.
“I saw it in the paper. I’m sorry, Izzie. Do you want me to come over?”
“No, but thank you. I’m okay. I just need to think about it.” That didn’t sound like a good idea to him.
“Are you sure? Let’s do dinner next weekend, when I get back from L.A.”
“No, I don’t think we should see each other anymore,” she said in a quiet voice, but she knew what she was saying. “I had fun with you. But I don’t think I can do this. Someone always gets hurt. I don’t want it to be me.” She knew instinctively that she needed to be with people she loved and who loved her, in order to heal. And Tony was never going to be that person. He could offer her fun but nothing else. He didn’t have it to give. He was still running away from his own grief. “I think we need to let this go, before we start it.” He was shocked when she said it, but he didn’t disagree. He could hear that she meant it, and he didn’t have anything more to offer her than he had given, a nice dinner, lunch in Napa, and the opening of the ballet. His own heart had been sealed off years before, for the same reasons. He couldn’t help her. And Izzie didn’t want to end up like him. Slick and superficial, however nice he appeared to be.
“I’m sorry, Tony,” she said seriously.
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