by Sanjay Gupta
Ty looked at the chart. “Ahmad,” he read. Oh yeah, the dad was Dr. Ahmad, the pediatrician. “Oh my God,” Ty said, “I knew him really well.”
The medic looked hard at him. “Well, then maybe you knew about his drug habit?” The medic paused. “Yeah, everyone’s favorite pediatrician was high as a kite when he rolled the family minivan.”
Just then the next chopper could be heard approaching the helipad with Mrs. Ahmad. “We need another neurosurgeon stat—who is on backup call?” Ty shouted. The nurse looked down. “Park,” she said. Sung Park.
Ten miles away at the county medical center, Park tried to collect himself as he stood staring at the scan. He was trying to find some explanation for what he was seeing. There was no mistaking it. He had gone from denial to anger to acceptance in the last five minutes and now his knees buckled. He reached out to one of the walls for support, knocking a six-year-old’s framed rendition of a butterfly to the floor. The shattering glass brought the doctor and a nurse.
Sung Park drove his Honda down the road back to Chelsea General with his MRI film in an oversize manila envelope. His eyes were red, and he subconsciously wiped away the moisture from his eyes. His pager was going off next to him, but he could not hear it. Rhapsody in Blue played on his car radio. He turned it up. It was one of the first American songs he’d heard in his homeland of Korea, and it was then he’d first dreamed of moving to the United States. There was something about that classical music infused with jazz that appealed to Park. It represented a sort of musical kaleidoscope of America, its melting pot, and its metropolitan madness. It had a steely rhythm and just enough rattle bang—Park used to play it over and over again in his tiny dorm room outside Seoul. His hands were perfectly placed at the 10 and 2 positions on the steering wheel, and he drove the speed limit. He ignored the person honking behind him, trying to pester him to drive faster. All he could think about was the number of patients he had seen over the years with glioblastoma. Some had lived as long as a few years, but most didn’t make it past 14 months—14.6 months to be precise. Ted Kennedy had lived about that long, and ironically so did George Gershwin, the composer of the music in Park’s car, a now morbid soundtrack to his life.
He made a single call after telling Milner—Miller, whatever his name was—that he was an idiot when he tried to console Park and tell him the tumor might be benign. He told Harding Hooten’s executive assistant, Ann Holland, when she answered, that he needed to see Dr. Hooten right away. At first, she was a little reluctant to schedule a meeting.
“It’s an emergency,” Park said.
He then fumbled with his jacket, scooped up his films, and walked out.
Park took the elevator up to the twelfth floor, walked down the hall and into Hooten’s office. He stared hard at the Rothko and then regained his composure. Since the time when he was a very young man, Park had relied on his determination and scientific mind, and he was going to use them now to improve his odds as much as he could. He had not gone through medical training twice to lose it all to cancer, he thought.
Hooten was waiting for him. “Sung,” he said by way of greeting.
Park slid the MRI out of its sleeve and passed it to Hooten. The chief of surgery pushed up his reading glasses and held it up to the light.
“Nasty-looking tumor. You are going to have your hands full with this one.” Hooten checked the name along the bottom of the MRI. “I would tell Mr. Song not to buy the family-size jar of mayonnaise.” Hooten shook his head.
“I am Song,” Park said evenly. “That is my film.”
“My God,” Hooten said. He appeared stunned.
“I want you to operate as soon as possible. Tomorrow. The day after tomorrow.” Park passed a list to Hooten. “Here is the name of the anesthesiologist, the nurses, and the others I want assisting with the surgery.”
“Sung, you should wait a week. Give you time to get your affairs in order?”
“Any delay will hurt my chances.”
“Yes, but I wouldn’t rush into this.”
“It’s not rushing. It’s the logical decision.”
Hooten looked at the film again for a long time and then up at Park. “You sure about this, Sung?”
Park felt a pang of doubt, but stared ahead with determination.
“All right, see you in pre-op at six.”
Park reached out and shook Hooten’s hand.
CHAPTER 14
V
illanueva sat on his stool in the emergency room, combination air traffic controller, conductor, and ringmaster. He didn’t need a radar screen, baton, or whip. The Big Cat waved his massive arms and called out like a carnival barker. He was in his element. He sent the fractured hip one way, a dehydrated child another, a baby with a high fever a third.
Paramedics brought in a drunk stinking of urine, his hair greasy and matted, his clothes filthy.
“Thanks for the gift, guys,” Villanueva said. “But I feel bad, I didn’t get you anything.” The paramedics smiled and rolled their eyes. They’d heard the Big Cat’s patter before.
“Catch us next time,” one of the paramedics joked back.
“Next time, you’ll be taking a case like this to county, right, boys?”
Another gurney arrived a moment later, refocusing Villanueva. This one carried a white-haired man knocked unconscious by his common-law wife. El Gato pointed to Trauma Bay 3.
The common-law wife walked in complaining of back pain, and Villanueva steered her to the opposite side of the OR, trying to prevent more fireworks between the two. She was moaning, saying “the bastard” had pushed her over a coffee table. This must be what it’s like to be a Hollywood maître d’. Keep the rival agents away from each other, Villanueva thought.
The cases were not always so benign. Chelsea General had the occasional gunshot victims from turf wars among gangs. Sometimes members of both gangs would arrive by ambulance, and Villanueva had to make sure there was plenty of room—and at least a couple of real cops—between the two sides. The hospital had its own police force but they were no match for the young gangsters. They kept people from parking illegally out front and wandered the halls giving directions to patients and family members lost in Chelsea General’s labyrinth. Villanueva called the ER’s regular cop on duty Barney Fife. He was a frail narcoleptic who spent much of his shift sleeping.
“Who’s got the back?” Villanueva called out, waving toward the woman who said she’d been pushed over the coffee table. “Smythe. That’s you.”
“Certainly, Dr. V,” Smythe answered. Smythe was originally from London and retained his Masterpiece Theatre accent despite living in North Carolina from age twelve on.
“Hey, Smythe,” Villanueva called out with an atrocious imitation of the junior doctor’s upper-crust accent. “Why is it I’m twice as smart as you and you sound twice as smart as I am?”
The nurses sitting behind Villanueva laughed. “You got that right, Dr. Villanueva,” one said. “He sounds smart with a capital S,” she added with an exaggerated English accent.
Another piped up, “I’d much rather have the gent with the accent take care o’ me.”
“You’re going to get the Big Cat angry!” a third nurse chided playfully.
A nervous-looking resident walked back studying a chart, trying to avoid Villanueva’s detection.
“Not so fast, Dr. Um-So,” Villanueva called out to him. The doctor’s real name was Kauffman, but everyone called him Dr. Um-So, though Villanueva was the only one who did it to his face. Um-So stopped.
Villanueva grabbed the chart the younger doctor carried. “You avoiding me?”
“No, Dr. Villanueva. I got this case.”
“What case is so important you can’t talk to the Big Cat?”
“Man complaining of bloody stools.”
“You’re choosing bloody stools over me.”
The nurses laughed.
“No, Doctor, um.”
“You’re saying bloody stools are more important t
han a little quality time with me. That’s what I’m hearing.”
Um-So was clearly flustered. He stammered but said nothing intelligible.
“Why are you wasting time with the case?” Villanueva asked. “It sounds like a job for Dick the Butt Doctor.” Villanueva never tired of this joke. Richard Lincoln was the chief of Proctology. He was an outstanding physician but that didn’t prevent him from being known as Dick the Butt Doctor. Villanueva returned his attention to Kauffman.
“You read all the journals. Tell me something I don’t know.”
Kauffman thought about it for a minute.
“Um so,” Kauffman began. His verbal tic appeared to be hardwired. Half a dozen doctors and nurses within earshot had to turn away so he wouldn’t see them laughing. “Noninvasive motion ventilation in COPD patients can be implemented—”
Villanueva interrupted again. “Saw that. Severe neurological dysfunction and pH less than 7.25 do not constitute absolute contraindications blah, blah, blah. Tell me something I don’t know.”
Kauffman thought for a moment. The hint of a smile on his face.
“Um so, laparoscopic surgeons who excel at video games make 47 percent fewer errors—”
“—and work 37 percent faster than their peers,” Villanueva finished for him. “Archives of Surgery. You can do better!”
Kauffman held up his chart by way of an excuse, but Villanueva shook his head.
“I’m counting on you.”
“Um so, did you know the word bedlam comes from the Bethlehem Hospital for the Criminally Insane, in London.”
“No shit?” Villanueva clapped Kauffman on the back. “Now, that’s interesting.”
Their banter was interrupted by the husband in Trauma Bay 3. Like a sedated lion whose tranquilizer had just run out, he sat up with a roar, startling everyone in the room.
“What’d she hit me with?” he demanded.
“Relax, Mr. Merriweather.” Johnson, the neurologist, gently pushed the man’s shoulders back down onto the examination table. “Looks like a large blunt object. Now let’s see how your eyes are working.”
Hearing the question, the common-law Mrs. Merriweather stopped her dissertation on back pain and her good-for-nothing, common-law husband and called across the room.
“It was the goddamn lamp.”
Villanueva scanned the room and located Barney Fife snoozing with a People magazine over his eyes. The Big Cat slid off his stool and sidled toward the midpoint between the feuding couple. Villanueva was once again ready to revive his offensive lineman skills and block a mad rush. When it became apparent the man simply wanted to know what had laid him low, Villanueva returned to his stool, directing traffic and conducting the ER symphony. On his way, he grabbed a doughnut from a three-day-old box sitting on the nurses’ desk. He took a bite just as he perched himself up on the stool, smiling. Two seconds later the stool simply collapsed. First there was a crack in one of the steel-reinforced wooden legs. As Villanueva started to look down, the other legs broke right in the middle, landing the seat of the stool and Villanueva smack on the floor. It was quite a sight, a 350-pound Hispanic man in barely fitting scrubs rolling around on the ground trying to right himself. More embarrassed than hurt, Villanueva eventually got his footing. Now that he was clearly all right, mild giggles started to break out in the crowd that had gathered.
Seeing the entire ER looking his way but pretending not to, he adjusted his scrubs and gave a small bow, inadvertently mooning anyone behind him. A couple of the nurses clapped.
Villanueva started to examine the remnants of the stool, half expecting to find an obvious defect. Then he looked around. “One question,” he boomed. “Was this stool already broken before I got here?” The giggles turned into uproarious laughter. Villanueva tried his best to look angry, but eventually joining the laughter while stuffing the rest of the doughnut in his mouth.
CHAPTER 15
S
ydney left the OR to answer a page. She wasn’t worried. The operation, a CABG, was almost done. She thought everyone knew the acronym until one day she received a call from the billing office where a new staff member wondered why Sydney had billed twelve thousand dollars for cabbage. Sydney had patiently explained it was coronary artery bypass grafting. “No, CABG was an acronym, not an abbreviation,” she had patiently explained. There was a response on the other end of the line, to which Sydney replied, “Actually, I am not the only one in the country to use that acronym,” with a little less patience.
The chest was still open, but senior resident Sanford Williams appeared to have everything well in hand when she stepped out into the scrub area. Williams had come a long way and was now one of the best young surgeons at the hospital. Sydney had a great deal of pride in her residents, and spent a lot of time training them in the operating room as well as in the animal labs. She had started with Williams seven years ago showing him how to attach skin grafts on the backs of rats. Now he was methodically sewing blood vessels together on top of a beating heart with suture too small to be seen by the human eye. Sydney was returning a call to the paging operator when she heard shouting from the OR.
She hung up her cell and hurried back into the OR. She saw Williams and nurse Monique Tran nose-to-nose—or they would have been nose-to-nose if Tran wasn’t a foot shorter than the surgeon. A tall Southern man, Williams wore clothes that would best be described as preppy when he wasn’t in the operating room. Even now, he wore a surgical scrub cap that had an argyle pattern. Tran, on the other hand, was a diminutive Vietnamese woman who wore Birkenstocks and baggy shirts. They were about as opposite as they came. Right now they both wore masks, but their narrowed eyes and their tone—even muffled—made their anger and frustration clear with most of their features covered.
Next to the doctor and nurse, bloody detritus was spread across the floor beside an overturned track bin fitted with a red bag for medical waste. Packaging, syringes, tubing, tissue, blue surgical draping stained dark, gloves, a couple of once-white towels, now crimson with splotches of blood. Above the mess on the floor, a rack held little bits of blood gauze, each in its own compartment.
Behind Monique and Williams, a junior resident stood frozen over the patient’s split sternum holding the large curved suture needle loaded with a wire.
“I don’t care,” Tran said.
“You don’t care?”
“I don’t care. The patient can lie there all friggin’ night for all I care.” Monique crossed her arms, a gesture of defiance and resolve in case he didn’t catch the meaning of her words. “No one is closing this patient until we find that four-by-four.”
“I did not leave a four-by-four in the patient,” Williams said, almost shouting. “That is not something I do.” Neither he nor Tran had seen Sydney come back into the OR. “You are so—Gây phiền nhiễu.”
“Chao? … Are you calling me annoying? Don’t try your god-awful Vietnamese on me. Look, maybe even the great Sanford Williams left a four-by-four in the patient…” Tran gesticulated.
Williams now crossed his arms and tilted his head back, appraising. Calmer now.
“Since when have you become so emotional?”
“Twenty-two went in. Only twenty-one came out. Either do an X-ray or help me find the missing four-by-four in the red bags. No one is leaving until we find it.”
“Like hell.” Williams turned to the junior resident. “Close him.”
“You want emotional?” Tran asked, poking Williams in the chest. “How’s that for emotional.”
“Jesus, Monique.”
The resident remained frozen over the empty chest cavity, needle and suture in hand. He was like an obedient child waiting to be told by a parent to start eating.
Sydney, too, watched and said nothing. She was trying to decipher what she was seeing. She knew the cause of the outburst must have been more than a missing 4x4, but she couldn’t figure out what. And since she couldn’t figure it out, she couldn’t decide what she—as the senior doct
or there—should be doing. And when the heck did Sanford learn Vietnamese? She waited and watched. She thought the answer to what was happening here might suddenly become clear. That was the nature of a puzzle. Look long enough, and maybe you will notice something you missed, just like Joanna Whitman. Yes, there was more than just a missing gauze at stake here, but what?
There was something else, though. There was a rawness and passion between these two, and suddenly Sydney felt the awkward thrill of the voyeur. She was watching something, for lack of a better word, “real.” And for that reason, too, she was loath to interrupt. So often the nurses and the residents acted around her the way they were supposed to act: obedient and eager.
Monique Tran glowered at Williams. The Red Hot Chili Peppers played loudly through the ceiling speakers, Southern girl with a scarlet drawl…
Sydney had playlists for the various parts of the operation. She liked Bryan Ferry or some other soothing vocals for pre-op and the initial incision. During the operation itself Sydney liked U2, which she always found uplifting. When it was closing time, the beat was hard and fast.
Without a word, Tran bent down on the floor and began sorting through bloody pieces of flesh, sterilization kits—everything that had been tossed in the medical waste bag during the two hours they had been operating. She was muttering as she did, a rapid-fire Vietnamese invective.
“You think I tossed it in here. Mr. Smart-Ass. I mean, Dr. Smart-Ass. We’ll see. You think you know friggin’ everything. You don’t even know how to say pho,” Monique said, not pronouncing the Vietnamese dish faux but more like fuh.
It was only now that Williams noticed Sydney taking it all in. The sight startled him.
“Dr. Saxena.”
Monique Tran looked up, and she, too, was startled to see Sydney Saxena standing in the OR.
“Dr. Williams. May I have a moment?”
Sydney did not like to countermand Williams, who was the surgeon in charge inside the OR in her absence. But she was the surgeon of record should anything go wrong. More than that, there was a right and a wrong, and in this case Williams was wrong. Sydney and Williams pushed through the double doors. She looked at the young surgeon.