by Sanjay Gupta
The student’s eyes widened. “What kind of mistakes?”
“All kind of mistakes. Morbidity and Mortality, some call it. Others call it Death and Complications. I call it the Someone Effed Up Conference. Capiche?”
“Can I come?” the student asked.
“You one hundred percent, absolutely, without a doubt cannot come,” replied Villanueva. “Did you not hear me when I said this was a secret meeting? Strictly invitation-only. No other doctors, no administrators, and certainly no friggin’ lawyers! This conference is for us, and us only.”
In the trauma bay, Wilson assessed the situation in just a few seconds. As he started to examine the young woman, he agreed with everything Villanueva had said. It was a classic case of chicken-and-egg in the world of neurosurgery. Doctors at many hospitals around the country would have heard the woman’s story and deduced in a matter of moments that the blood in her brain was a result of the car accident. They would also deduce that since she’d been in a single-car crash into a telephone pole, she was trying to kill herself. The truth was far different. The aneurysm, a small blister on the surface of an artery, had suddenly let loose, spraying blood throughout her brain. She had likely felt a sudden thunderclap headache, and within seconds was rendered unconscious. That was why she’d crashed her car. In this case, the aneurysm was the chicken. The car accident was the egg. The science of deduction, and Ty knew there was no one better at it than Villanueva.
Ty’s beeper went off again. Like Villanueva’s, it read 311. 6. He took the message like a punch, sucking in air involuntarily. Tomorrow morning, he was going to be where no doctor at Chelsea General wanted to be. Ty forced himself to breathe out slowly, then caught Villanueva’s eye across the room. He wanted to see if the trauma chief had gotten the page. One glance at Villanueva’s expression of near pity, and Ty knew he had. Damn, Ty thought. The last thing he wanted was the fat man feeling sorry for him.
Villanueva muttered to himself, “Poor bastard.”
CHAPTER 2
I
n the neurosurgery offices up on the twelfth floor of the hospital, a single light still shone along the long hallway, leaving the beautifully framed pictures of neurosurgeons present and past adorning the walls in subtle darkness. The names were all giants in the world of surgery: Edgar Kahn, Richard Schneider, Lazar Greenfield, Bob Bartlett, and Julian T. Hoff, who was widely credited with building Chelsea General into the powerful institution it now was. His nickname BUZZ was engraved under his name. The last picture was of Harding L. Hooten, the current chairman of surgery. Underneath the beautifully engraved wording of his name was his simple nickname: THE BOSS. There were also several museum-worthy paintings Hooten had requested through old-boy connections in the art world, also in shadows at the late hour.
Right outside his office was one of his favorites, Mark Rothko’s Untitled 1964, which was on loan from the National Gallery of Art. The abstract painting consisted of a large black rectangle with a dark gray rectangle inside. No one knew why the Boss liked it so much, but no one dared ask. There was a large Cy Twombly abstract and a David Hockney photo collage, also on loan, and a couple of John James Audubon prints Hooten brought from home. One showed a yellow-crowned heron, the other, a South American scarlet ibis. This particular ibis was one of the few birds Hooten had never seen with his own eyes, and he had spent a lot of his life hunting for the bird around the world. Most people who saw the art either had no idea of the works’ gilded provenance or assumed they were reproductions. The air smelled of the expensive cologne that seemed to linger around Hooten’s office.
Amid the grit of Chelsea General, Neurosurgery was far from the norm. Many other departments were so strapped for decorations that doctors would frame their children’s artwork and hang that up, or order the type of forgettable prints of generic landscapes or flowers more at home in discount hotels—anything to distract. Neurosurgery was so atypical that several faculty members were embarrassed by the appearance and often took pains to see their patients in other areas, instead of the museum-like atmosphere of their own department. Few things killed rapport with patients more than the impression that the doctor was getting rich treating them.
Inside one of the more modest offices near the end of the mostly dark hall, Dr. Tina Ridgeway sat next to a tired-looking junior resident holding a bag of microwave popcorn, a whiff of melted butter in the air. There were a few framed pictures on the bookcase in the corner. One was of a couple of young girls in cheerleader uniforms. Another was a wedding picture of a very pretty Tina and her new husband. There was a picture of the whole family crouched around a young girl in a wheelchair. Everyone was smiling, almost laughing in the picture, including the girl in the middle. They sat on a couch across from Tina’s desk, peering at Michelle’s book of neuroanatomy lying on the coffee table. The picture showed the two lobes of the cerebellum, and all the various blood vessels that supplied blood to the back of the brain. There were a lot of nonsense scribbles on the page, in typical doctor’s bad handwriting.
“C’mon Michelle, I’m not leaving till I’m sure you understand this,” Tina said. While Michelle slouched on the couch with a few kernels of popcorn sitting in her lap, Tina sat up straight. She looked crisp and in command. “Tell me again, what are the different types of posterior fossa tumors in children, and how you would manage each one?”
Michelle nervously adjusted her glasses. “Uh…medullo…uh, something like that.” She stammered something incomprehensible. Then she just sat, dejected and embarrassed.
Tina offered the younger woman some more popcorn as though that might fuel a burst of understanding. Michelle Robidaux was a resident pretty much everyone in the department had given up trying to help. She’d failed the boards twice, and all the faculty members were waiting for her to either quit or be fired. They ignored her during teaching rounds and hardly called her name when they needed a resident to scrub in on a case. They even asked senior residents to take extra call so Michelle was never allowed on call by herself. That served to alienate her even further from her colleagues. What they hadn’t counted on was Dr. Ridgeway’s unfaltering support for the young woman. The neurosurgeon had convinced all of her colleagues to give Michelle one more chance and allow Tina herself to mentor her. Some of her colleagues were sure Tina felt sorry for Michelle more than anything else. After all, Tina had grown up with everything, and Michelle, by all accounts, had been brought up on the wrong side of the tracks. This type of extra help was unheard of, considering Tina’s packed schedule as well as her husband and three children at home. Still, here Tina was teaching long after her family ate dinner, again, without her.
The contrast between the two women was striking. Aside from the fifteen-year gap that separated them, Dr. Tina Ridgeway was gorgeous in a way that went beyond her flawless skin, high cheekbones, and the kind of lips lots of women were paying lots of money to replicate. She carried herself in a way that somehow suggested elegance and grace, unheard-of commodities in an urban hospital like Chelsea General. Even though Tina always wore her hair pinned back and was rarely found in anything but scrubs, male residents from all over the hospital could be found furtively walking the hallway in front of her office for no apparent reason. They called her Chelsea-Lina, given her resemblance to the famous movie actress. Anyone spotting Dr. Ridgeway outside the hospital might guess that she was in the fashion business, or maybe a politician or community leader. She was the kind of woman who seemed to attract attention without trying.
Michelle Robidaux, on the other hand, was a face in the crowd. She was slightly overweight, medium height, with bad posture, stringy hair, and skin pocked by teenage acne. She always looked tired and besieged, even after the rare full night of sleep. Still, her story was remarkable. She was from a small town in Louisiana, where most of her family lived under the thumb of relentless poverty. Her parents raised chickens and grew vegetables and sugarcane, eking out a living on the small patch of land south of I-10 between Lafayette and Lake Ch
arles. Michelle’s father had quit school in eighth grade to help his own father with the farm. Her mother made it through high school, but college was out of the question. Michelle’s grandfather was a mechanic who fixed mowers, boat engines, pretty much anything customers wanted to drop off and didn’t care if they didn’t get back for a month or so. Papi Bill was a clever enough mechanic but he was also a whiskey man, Southern Comfort specifically. “Created right here in Louisiana,” he often said when he poured a glass, and drinking it was always the first order of business. He’d start the day with a tumbler of SoCo and Coke, along with a couple of Tums. By midafternoon, he was skipping the mixer and the tumbler and could be found on a folding chair outside his workshop, drinking straight from the bottle, much of his unfinished work scattered in front of him like lawn decorations.
Michelle’s parents were too overworked to care much about the public school she attended, where teachers considered anyone who showed up regularly and stayed out of trouble to be a standout student. Not only did she show up, but Michelle proved herself different right from the start. She turned in her assignments. She asked smart questions, often beyond the ken of her teachers: “That’s an excellent question, Michelle. Why don’t you look it up yourself, come back tomorrow, and share your answer with the class.”
Most of all, Michelle was a voracious reader. In books, she could forget about her growling stomach, indifferent parents, and two older brothers who were drinking and stealing before they were teenagers. Michelle exhausted her elementary school’s library by third grade and moved on to the town library, where she caught the interest of the librarian, a matron named Mrs. Truex whose dowdy clothing and cat glasses on a chain were right out of central casting. Bobbie Truex had a brother, Rex, who had emerged from the town’s middling schools to become a successful car dealer in Baton Rouge. When he heard about the remarkable girl frequenting his sister’s library, Rex became a patron of sorts for Michelle, first encouraging the girl on visits to his hometown, telling her she could do whatever she wanted, and then paying her expenses in college.
To say Michelle was the first member of her family to graduate from college was true but missed the point: She was the first Robidaux to consider college. To them, college was a place for rich kids. Sure, college kids may have book smarts, but the only book that counted for Michelle’s family was the Good Book. As for medical school, becoming an astronaut would have seemed less alien to family and neighbors living across the flat, sun-scorched stretch of land wedged between the Gulf and I-10. There wasn’t a single medical school graduate from her zip code. Michelle’s story was a testament to her resolve. Now, though, the young woman began to wonder if she had traveled beyond the limit of that innate drive and intelligence. Maybe her reach now exceeded her grasp. Maybe striving to become a brain surgeon was too much for her. She thought about her upbringing and a family tree known more for boozing, brawling, and petty crime than any kind of success. For the first time in her life, Michelle started to question herself.
Prior to her arrival at Chelsea General, Michelle never doubted she was as smart as her Ivy League colleagues. But twice now, she had failed her exams, and it seemed everyone had abandoned her. They had been so excited to accept her into the program, and reveled in the telling of her story: See that young doctor, she was raised on a dirt-poor farm. She was an oddity to them, yet they took great pride in her achievements. They patted themselves on the back for taking her in at their prestigious hospital. Now only Tina Ridgeway seemed to care. A John F. Kennedy quote Michelle had first learned in second grade came uninvited and hit her like a slap: “Success has a thousand fathers; failure is an orphan.” She was fast becoming Chelsea’s orphan.
Tears formed in the corners of Michelle’s eyes, and she wiped them away with the backs of her hands before they could begin an unprofessional path from her tear ducts, past the conjunctiva, and down her cheeks.
“All right, look, Michelle, I know you’re tired. Let’s pick this up tomorrow,” Tina said.
“Thanks, Dr. Ridgeway,” Michelle said.
“Tina,” Ridgeway reminded, “call me Tina.”
“Right, Tina.”
A beeper went off, and both doctors reached for their sides.
“It’s mine,” Tina said. She was hoping it would be Ty. It said simply, 311. 6. A cloud crossed her face.
“Are you all right, Dr. Ridgeway?” Michelle asked.
Ridgeway sat staring at her beeper, and answered without looking up.
“Again, Michelle, it’s Tina, just call me Tina. And yes, I am fine,” she answered, perhaps a little too harshly. Tina realized her worry about Ty must have been broadcast across her face, and she quickly composed herself. As hard as they worked to keep it a secret, the hallway whispers had started. What’s going on with Ty and Tina? Are they dating, sleeping together, and what about her husband? It probably didn’t help they ate lunch together and often sat next to each other at conferences. If Tina had a question about a patient, she always took the case to Ty. Still, it would probably surprise other doctors at Chelsea General to know that Tina had spent four nights in the last two weeks at Ty’s apartment.
Tina knew life had a few hinge moments, when your actions or inactions could dictate your remaining path. That first night with Ty was one for her. It was both an admission and an indulgence: an admission that her marriage was all but over, and an indulgence in something improper. Her husband just assumed she was on call and was busy at the hospital. Truth was, he had stopped caring a couple of years before.
Now everyone was saying Ty Wilson might get fired or even worse. Ty hadn’t even told her what had really happened in the operating room that night. He hadn’t told anyone. But he was going to have to divulge all the details in Room 311 at 6 AM tomorrow.
CHAPTER 3
A
cross town in Dr. Sung Park’s house, dinner had just been cleared. His wife, Pat, had loaded the dishwasher, wiped the table down, and packed away the leftovers. There was not a speck of food to be seen, and the house was almost silent. This was especially odd considering there were three children under the age of six. Everything in the home smacked of bargain shopping, right down to the sensible dress Pat wore. It had been on sale for 70 percent off at a wholesale department store. Still, Sung had given her a disapproving look when she showed him the bill.
The children were reading to themselves, the only sound coming from the turning of pages. Even the two-year-old was flipping through a cardboard book of animals without uttering a sound. Pat Park admonished the five-year-old when she giggled at something she had read.
“Your father is working,” she said. Sung sat in his study reviewing a detailed paper on conjoined twin surgery. He was making meticulous notes, and drawing the operation step by step in a notepad he carried with him everywhere. He also used the exact same kind of pen every time. It was a red uni-ball micro pen with a .38mm tip. They cost fifty cents apiece at the office supply store, but Park got them for free. He pocketed them from the various department secretaries’ desks when they were away. Now he was using them to detail a picture of two infant heads pointing in opposite directions with a band of veins still connecting them. He made bullet points of how much blood-thinning medication would be given at this point of the operation, along with the desired blood pressure of each twin. Even though their names were written on the medical records, he called them simply twin A and twin B. Bad luck to use real names, he thought to himself.
The following day, he was going to try to edge his way into the operating room, where his chairman was scheduled to separate the conjoined twins. Every other neurosurgeon including the legendary Ben Carson had turned the family away, saying it was too risky.
Still, “the Boss,” as everyone called the chairman of Neurosurgery, was going to operate. Sung had been trying to take over the case, and when the chairman didn’t budge, Sung had even tried to undermine him. He’d gone to the CEO of the hospital to remind him that he had a lower complication
rate than the Boss. Sung had done his research, and learned the CEO, like many heads of hospitals, really didn’t know anything about medicine, let alone brain surgery. So Sung had collected data. He handed the CEO a folder of information, including not only his low complication rates, but also his operative times, which were second only to Ty Wilson. He also had carefully copied his drawings of the operation step by step, and placed that in the folder, which Pat had bound for him this morning. The CEO pored over the papers for a few minutes, took a couple of sips of coffee, and then started grinning. For several seconds he didn’t say a word, he sat just grinning and impassively staring at Park. Park thought the man might be having atypical symptoms of a stroke. Just as Sung was about to say something, the CEO came around the desk and put his hand on Sung’s shoulder, like a schoolteacher might with a fifth grader. “I am telling you, Hooten find himself between eight-ball and hard place,” Sung said. He regretted it as soon as the words had come out of his mouth. He had mixed up his metaphors, something that was very embarrassing to him. The CEO smiled and walked back behind his desk. “No he won’t, Sung. He may find himself behind the eight-ball…or he may even be between a rock and a hard place…but not between an eight-ball and a hard place.” Sung turned bright red, and the CEO waved him out of the office. On his way out, the smug ass had told Sung he should sit in the corner during the operation and take notes. It was all Sung could do to keep from screaming. After all, he had completed not one, but two full neurosurgery training programs. After he became a full-fledged neurosurgeon in his homeland of Korea, he emigrated to the United States, only to be told his training would not be enough to become certified. He was asked to complete another seven years of training, working well over a hundred hours a week. It would’ve dropped most men to their knees. Not Sung. Even though he was a full decade older than his co-residents at the time, he outworked them and beat them every step of the way. At the same time, he had studied and practiced weekends and nights to master the English language, although he still spoke with a choppiness that seemed to worsen when he was angry or nervous. He knew he would never even have a chance at becoming chairman himself unless his English was better. Being a foreigner was one thing. Sounding like a foreigner was another. The teenager at the kiosk in the local mall had smirked when he purchased Rosetta Stone for English from her.