by Sanjay Gupta
“Monique is such an obstructionist—” He stopped, blushed, then awaited word from his attending.
“She’s right. Look, every year, more than a thousand patients have something left in their body during surgery. In fact, it is closer to fifteen hundred. It is not a sign of weakness to forget something—but if you never bothered to check, well, that is unforgivable. Not to mention, my name is going on the operative record. I don’t want to be coming back here tomorrow to dig out your gauze. I don’t want to get sued, and I sure as hell don’t want to be in front of the rabid spectators in the coliseum next Monday morning.” The last comment got Williams’s attention.
“Either you order an X-ray or I do. Or you can join Monique on the floor with the red bag waste.” Sydney was trying hard to act the way Hooten might in a situation like this. It was no secret to anyone that she was angling for his job one day. “You can’t close up the patient without knowing.”
Williams pursed his lips and sucked air through his nostrils. He turned and pushed his way back into the OR.
“Okay. We’re doing an X-ray.” Twenty minutes later the missing 4x4 rectangle of gauze was located in the patient’s chest cavity.
CHAPTER 16
T
he operation on the Ahmad boy was straightforward and had gone well. The boy was awake now, and was starting to ask questions. Ty shined a bright light into both his eyes and asked him to lift both his arms in the air. He looked at the curvilinear incision he’d made on the boy’s scalp. Ty silently dictated into a small recording device that would produce an electronic record for the boy’s chart. “Pupils are equal, round, and reactive,” Ty said. “He has full power in all four limbs, and he is oriented to person, place, and time,” he finished. He wanted to add, The boy still doesn’t know his father is dead or that the kindly pediatrician had smoked a joint prior to buckling his son into the car. He thought better of it. Hooten had emerged from his twelfth-floor sanctuary to help operate on Mrs. Ahmad. Surprisingly, he wasn’t at all upset that Sung Park couldn’t be located. Mrs. Ahmad was still sedated, but she would wake up soon to start reassembling her family’s shattered lives.
Sandy Shore’s Rathke’s cleft cyst had also been completed without incident. Mac was a quick learner with good hands and an unshakable confidence Ty now envied. Ty mused that he was now on the outside, looking in. No matter how many ways he surgically dissected the situation in his mind, he kept coming back to the same conclusion. He had all but put a gun to Quinn McDaniel’s head and pulled the trigger. It was an assassination. Isn’t that what you would call a reckless mistake like the one he’d made? He felt a little spill of gastric acid in his stomach. The boy’s death had shaken his mojo, his wa, the kind of fusion of thought and action that the philosopher Mihaly Csikszentmihalyi called flow. Whatever Ty once had, he now realized he had lost it. The pressing question was: How could he get it back? He tried not to think about what he’d do if he couldn’t.
Changing out of his scrubs, Ty thought about how quickly his confidence had fled. He had done the two spines without a thought, and then seized up when he needed his skills most. He had started thinking, and that was it. The doubts flooded in. He made a mental note not to think too much and almost nervously laughed out loud. The quickest way to obsess on something was to try not to think about it. Just ask any baseball player in a batting slump, or basketball player at the free-throw line.
Ty had been a standout athlete in high school. He pitched and played outfield for San Luis Obispo High, and was shooting guard for the Tigers basketball team. Ty remembered teammates with mental blocks that crippled their abilities to perform in games. Don Blankenship, the first baseman on his baseball team, would choke when he had to make even the shortest throw. His arm would move forward and the ball would travel almost straight down into the ground. Fortunately for the Tigers, first basemen did not need to throw often. This strange mental block was not limited to obscure high school players. The New York Yankees’ Chuck Knoblauch had suffered a similar curse. And there were well-documented cases of major-league pitchers whose careers were ruined when they suddenly lost their pinpoint control.
Then there was Ty’s teammate on the high school basketball team, a sinewy power forward named Trent Brown. He missed a foul shot in the district finals one year and from that point on made only about a third of his free throws, an abysmal percentage. Ty thought Trent’s horrific foul shooting cost him a Division I scholarship—all because he could not overcome the belief he could not perform the simple act of shooting a ball into the hoop from the free-throw line fourteen feet away.
Golfers called these jitters “the yips,” and sports psychologists made good money helping athletes overcome these mental hang-ups. Of course, sports were not the only arena where you could choke. I’m proof of that, Ty thought. Remembering his days as a standout athlete gave him an idea. He was supposed to prepare a lecture on the use of the hormone progesterone for traumatic brain injuries. It was an idea he’d developed with one of his colleagues in the ER. They noticed women often did better than men after similar head injuries. They thought it might be the female hormone progesterone that was somehow protecting the brain. Turned out they were right, and Ty wrote his fifteenth publication for the New England Journal of Medicine. Instead of working on his talk, he left the hospital on his Hayabusa, went home to his condo, and changed into shorts, a T-shirt, and high-tops. He took a quick peek in the mirror and pushed away a couple of gray hairs that had started to creep in along his sideburns. His cobalt-blue eyes looked right back at him, challenging him. Then he drove down Oak Street to a local elementary school playground where high school players and a few adults gathered in the afternoons to play basketball on the asphalt court. Ty left his pager behind.
When they chose up sides, Ty was picked last, but he stayed with the run-and-gun high schoolers, to the younger players’ surprise. Ty’s game was typically smooth. He moved fluidly, cut quickly, and found an open space to take a pass, square up to the basket, and let loose with his textbook jump shot. He was also a smart player. He anticipated where the ball was going to be. He put his body in position to get the offensive rebound, set a pick or dodge one, box out the opposing player on defense, kick out for a fast break. He quickly gauged his most useful role on a pickup team and filled it, whether it was shooting, rebounding, or ball handling. As a result his teams usually won. These were all products of his restless childhood days in California, playing hours upon hours of pickup basketball, playing at every opportunity until his focus shifted from petty crime and sports to doing whatever it took to be the best surgeon he could be.
But as they moved up and down the court now, Ty did not find his rhythm. The first time he got the ball on the wing, he hurried his shot and missed the basket entirely. The next time, he drove to the basket but had the ball stripped from his hands by an opposing player half his age. The player raced downcourt and laid the ball into the hoop.
After that, Ty knew he wouldn’t get another pass, so he did his best hustling up and down the court looking for loose balls and rebounds. But his knack for finding his space on the court and his role on the team eluded him. He was bumping into his own teammates, and they were becoming aggravated with the “old man” they’d been stuck with. Instead of finding a spot under the basket and holding it, he’d tried to bully his way past the opposing teammates.
Ty usually found the hard-charging up and down of a pickup game tiring in an exhilarating way. But as he ran the length of the court chasing another layup by the other team, Ty found himself enjoying his exhaustion only as a form of self-punishment. Breathing hard, he grabbed an offensive rebound and went up hard against a rail-thin high school student. The teenager fell back, holding his nose.
“Damn, man,” someone said behind him as the defender sat on the hardtop and dabbed his nose with a T-shirt.
Ty breathed a big sigh.
“Sorry about that,” Ty said. He reached out his hand as a gesture of conciliation. The
high schooler swatted it away.
Ty turned and walked off the court with a wave. As he made his way to his motorcycle, he felt none of the normal pleasure of exercising his body to exhaustion. He felt irritable, and then it occurred to him that he had been playing in anger, not with joy. He’d had the idea that the release of hoops, the physicality, would somehow cleanse him of the mental demon that was stalking him. It didn’t. As he drove home, the fear remained that he would choke during his next operation—or worse, that he would perform the operation with catastrophic results. Ty noticed his breathing was elevated, and it wasn’t from the basketball. He needed to do something. He needed to shake this doubt that gripped him—that had infected him like a retrovirus. Ty had an idea. More accurately, he returned to an idea he’d had a week earlier.
Ty showered, changed, and then checked his wallet to see if he still had the scrap of paper he had placed there. He did. He checked the address on Google Maps, got his car, and drove to an apartment building a few miles from his own, behind a Kroger grocery store. Ty took a deep breath, got out of the car, and walked to the building.
Confronting his fears head-on had been Ty’s credo since his brother’s death.
Ty rang the buzzer under the name A. MCDANIEL—5H.
“Yes?”
“Allison, this is Ty Wilson.” There was a pause. “Dr. Wilson. From Chelsea General. I wondered if you had a moment.”
There was another pause, followed by a buzz. Ty pulled the door open and took the elevator up to the fifth floor. The carpet in the hallway was worn, and the lighting was dim. Ty knocked on the door. Allison opened it a moment later, looking a little suspicious. When he had seen her before, her hair was pulled back and she was dressed in a gray pantsuit. Now her shoulder-length hair hung loose; she was wearing blue jeans and a simple V-neck white T-shirt. She was barefoot. She looked younger than she had at the hospital but also very tired.
“Hi, Ms. McDaniel. Allison,” Ty began. He realized he had not thought about what he was going to say when she opened the door. He had another reflexive thought: that she was a beautiful woman. “I was wondering if we could talk. I’ve been thinking about your son.”
Two small children ran around behind Allison. Ty looked at the children, who looked so little they could be Quinn’s younger siblings. Allison saw his confusion.
“That’s my niece and nephew. Since I lost my job, I’m watching them for my sister.” Ty didn’t know what to say. He saw the woman swallow hard. “Listen, it’s hard to talk when I’m watching the kids. You want to get a cup of coffee sometime, call me. There’s a Starbucks just down the street.”
She held up a finger for him to wait and disappeared for a moment. When she returned, she handed him a piece of paper with a phone number on it.
“There’s my cell phone number.” Her voice was calm, flat, and noncommittal.
“Okay. Thanks.” Ty took the paper as Allison shut the door. He lingered for a moment outside the door. As he walked away, Ty wondered what he was thinking by showing up at her apartment unannounced. What could she give him? She had lost everything. He knew he should feel selfish for what he had just done, but for the first time in a while, he felt a slight sense of relief.
CHAPTER 17
T
ina sat at the large farm table in the kitchen sipping a glass of expensive Chardonnay. Her husband, Mark, stood by the six-burner Wolf stove holding a spatula as he pan-fried sole. A covered casserole dish with green beans amandine rested on the counter. Their six-year-old daughter Ashley sat between them in a wheelchair specially designed for children with cerebral palsy, with a tray like a high chair. The girl’s head lolled to one side. The sounds of two older girls singing a pop song in another room drifted into the kitchen.
“You’re not listening,” Tina said.
“I am listening,” Mark said. Between him and his wife, an air of tension. This palpable, almost visible wall had been growing for months now, adding a sharp and clipped edge to their words, making their conversations strained. But they were still married; they were still roommates. They needed at the very least to relay information about the children and their own schedules.
Mark’s schedule had become a lot less complicated. He’d lost his job as an architect when the Michigan economy cratered. He was now home full-time, and his initial flurry of job hunting had waned to nothing. Few job seekers were as unattractive in the market as an architect. Builder maybe. So Mark had shifted his energies to their three daughters. He helped the older girls get ready for middle school and then took Ashley to day care in the morning. In the afternoon, Mark was home with Ashley until the older girls returned home on the school bus. His plan had been to get in shape during his free time in the morning, but as often as not he returned to bed and slept the morning away. He didn’t have the energy. Just listening to Tina seemed to require more energy than he had.
“Michelle Robidaux has a single bad outcome—something that could have happened to any of us—and they’re going to ruin her career.”
“Shit happens,” Mark said. “Wasn’t that what you told me when Richter and Griffin sent me packing?”
“Mark!” Tina motioned toward Ashley, who banged on her tray.
“Sorry. Didn’t you say she was having trouble anyway?” Mark asked.
“That’s not the point, Mark,” Tina said in a tone that was both cold and condescending. “The hospital is supposed to stand by its people.”
They had been married for fifteen years, and he seemed to Tina to be willfully ignorant of the way medicine worked. He had his head in the sand. No wonder he’d had no clue he was going to get canned when his firm needed to tighten the belt.
“I really don’t think you listen to me. You hear what I’m telling you, obviously, but are you really listening? We’re talking about a young doctor here. I think you’re in your own world. Hospitals are supposed to protect their people, not toss them when there are problems,” Tina said, with emphasis as though that might help her get through to her husband.
Tina’s husband turned to the stove for a moment to flip the fish. His mouth was closed and his gaze was fixed on the pan. She could see the masseter muscle flexing on his jaw. He paused a second and then turned back to Tina and pointed the spatula at her, his voice now erupting with anger.
“Wives and mothers are supposed to stand by their people, too.”
“Excuse me?”
“How well have you stood by your husband? Or your children? It has been an incredibly difficult year. We’ve had our troubles. We’re having trouble, and where are you?”
“Mark, what are you talking about?”
“You’re never here. I can’t even reach you when I need to.”
Ashley banged on her tray again and made a keening noise. Tina looked at her daughter, then Mark, but said nothing.
“Any nurse or resident or physician can reach you all hours of the day, any day of the week, but I couldn’t get hold of you at the hospital most days if my life depended on it.”
“Where is this coming from?” Tina asked.
Ashley knocked one of the toys off her tray, and Mark reached down to pick it up. He had tears of frustration in his eyes when he stood up.
“Where did it come from? Right here. It comes from me,” he said.
Again, Mark went back to the stove. He turned the burner off and walked to the doorway.
“Madison. Mackenzie. Dinner,” he called.
Tina looked at him, her lips pursed, with an expression suggesting indifference.
Mark grabbed a stack of plates and quickly set them around the table, not looking at Tina as he slammed a plate down in her spot. Mark grabbed paper napkins, forks, and knives and put them around the table. He then went to the stove and placed the fish on a serving platter.
Tina and Mark were glowering at each other when the two teenage girls burst into the room. The moment they entered the kitchen they saw the tension between their parents.
“What’s for din
ner?” Mackenzie asked. Madison walked over to the stove and peered into the frying pan.
“Gross. Fish? Again,” Madison added.
“That’s rude, Madison,” Tina said. Her voice was calm. “Apologize to your father.”
“Sorry, Dad. But it is gross.”
“That’s it—go to your room,” Tina said. “Go to your room, now.”
“Mom!”
“It’s all right,” Mark said, looking at his wife. “All things considered, it’s a relatively small slight.” Tina glowered.
The older girls looked from their father to their mother and sat down to dinner. Their eyes downcast, they began eating in silence. With tears streaming down her smooth cheeks, Mackenzie stopped eating and looked up.
“It tastes good, Dad,” Mackenzie said.
“Thanks,” Mark said. His voice was flat.
“Is everything going to be okay?” Mackenzie asked, her voice now breaking with sobs. The question caused Madison to start crying. Ashley banged on her tray. The question hung in the air for a moment. Mark said nothing. He turned to Tina as though he, too, wanted an answer.
Tina turned to the girls.
“Don’t be ridiculous, Mackenzie,” Tina said in a voice as soothing as she could make it. “You’ll see someday. Marriage is…” She paused. “Marriage is not always easy, but your father and I love each other.” Tina spoke almost as though she was trying to convince herself. “Come here. You, too, Madison.”
The girls walked over to their mother. She turned in her chair and opened her arms. The girls folded their lanky bodies into Tina’s embrace. Mark watched, lips pursed, as their two daughters bent and nuzzled with their mother.