by Sanjay Gupta
“More bands should take advantage of our rich nomenclature,” Villanueva said. “Like ‘Palpable Mass.’ A band with a name like that could be big.”
“Nice,” Ty said. “How about ‘the Myoclonic Jerks.’”
“I like it,” Sydney said.
“‘The Suppurating Sores,’” Villanueva added.
“Glad I’m not eating,” Tina said.
“‘The Constipated Stools,’” Ty added.
“Now you guys are just getting gross,” Sydney said, laughing.
CHAPTER 28
T
en minutes later, Sydney arrived on the clinical patient care floor. The senior resident Melody McHenry, blinking back fatigue, greeted her in the hallway next to the nursing station. She ran through the relative state of recovery of patients who had undergone operations in the previous forty-eight hours.
Almost as an afterthought, she added, “We had a surgical consult from pediatrics. A five-year-old with a minor hit to her head and a history of surgical repair of a volvulus arrived in the ED yesterday afternoon. Vomiting. Constipation. Lethargy. Latham did a consult last night. X-rays and KUB film showed dilated loops of bowel, possible early partial bowel obstruction. He gave the girl two 250cc boluses of normal saline, plus five percent dextrose in half normal saline at 40cc per hour. Inserted a nasogastric tube and admitted. He asked me to take a look a few hours ago, but I got kind of busy with these other patients.”
Sydney listened, her expression becoming one of concern.
“So, no one has seen her overnight? Where is she?”
“She’s on Five-A.”
“Let’s go.”
McHenry and Sydney walked back the way Sydney had come, McHenry scurrying to keep up.
“I was told by the nurses that she looked stable. Abdomen nondistended. No sign of peritonitis.”
“Did you do another KUB?”
“Um, no,” McHenry said. “I asked for an infectious disease consult. Also, I’m getting our pediatric surgical fellow to take a look.”
“What’s happening to the blood count?”
McHenry didn’t answer. She didn’t know.
Sydney began walking faster still, moving ahead of McHenry. She pushed through a doorway outside, cut across a patient drop-off bay and into another double door.
“What room is she in?”
Before McHenry could answer a nurse intercepted them in the hallway. Her grave expression matched Sydney’s.
“The girl in room two forty-five doesn’t look right.”
“Two forty-five. That’s her.”
“What’s going on?” Sydney asked.
“Real lethargic. Didn’t respond to a needle stick.” As most pediatric nurses know, it is an awful sound when a child cries while getting an IV. Silence, however, is far worse.
Sydney and McHenry went into the room, the nurse a step behind. Sydney picked up the chart at the end of the bed and took out her stethoscope. The girl was thin, with brown skin that appeared somehow chalky. She looked tiny in the big bed. Sydney held the stethoscope to the girl’s chest, checking her watch as she did.
“One ninety-two.” She flipped through the chart. “The blood count had a shift to the left.” Sydney gave an accusing look at the senior resident but said nothing. “We need an OR. Now.” McHenry rushed from the room.
Sydney turned to the nurse. “Have somebody find this girl’s parents, someone to give us consent, and have them meet me at Inman Seven. Start antibiotic therapy and get her to Pre-Op.”
Sydney walked fast down the corridor, through a tunnel, and then up one flight to the reach the ORs.
Within the hour, the girl was intubated and lying unconscious with her gut opened. Sydney scrubbed in with the pediatric surgeons and located a foot-long section of dead bowel. When they heard the girl had lost consciousness as she was being moved from the bed to a gurney, the doctors were sure they had the right diagnosis. Sydney placed clamps on either side. Before she could start removing the foot-long section, the drone of a flat-lining EKG interrupted her. The anesthesiologist dropped her book and jumped up. She checked the leads on the EKG, saw that they were still connected, then reached onto the cart and grabbed a small vial.
“Point one m-l epinephrine bolus.”
She took a syringe, drew the drug from the vial, and squeezed the clear liquid into the IV port.
Sydney began chest compressions, and the anesthesiologist started trying to put in a central line.
“Let’s defib,” Sydney said.
The circulating nurse picked up the defibrillator, removed the blue drape from the girl’s chest, and placed the paddles against her skin.
“Clear.”
The shock jolted the small body, but the EKG continued its steady beep.
Sydney and the anesthesiologist took a half step back. The anesthesiologist grabbed another syringe and drew liquid from another vial.
“Adding point five milligrams atropine.”
Sydney and the anesthesiologist continued with the CPR, with Sydney doing the compressions and the anesthesiologist pushing the medications. The pediatric surgeons placed damp sterile towels over the young girl’s abdomen.
The nurse rubbed the paddles together as the device recharged.
“Clear.”
She returned the paddles to the girl’s chest and hit the button. Again the small body jolted upward.
This time, the EKG began beeping a regular beat. Sydney let out a long, slow breath. She waited to see if the girl’s heart was back.
The rest of the operation went without complications. Sydney left the OR and without changing her scrubs, went up to Hooten’s office. She walked past Hooten’s startled receptionist into the chief of surgery’s office.
Hooten was on the phone.
“Morgan, I need to call you back. There’s something I need to attend to. Dr. Saxena?”
“Harding, I’m worried about complacency at this hospital. I just had a little girl who almost died because of a casual attitude toward diagnosing what turned out to be an emergent situation.”
“You’re the attending, Dr. Saxena. I suggest you put the fear of God in whatever residents or interns are responsible.”
“This isn’t the first time. And it’s not just my service. Ordering tests and asking for consults are easy at a hospital like this. We need our young doctors to take responsibility. We need them to behave more like country doctors.”
“Very well. We’ll have a mandatory seminar this coming Saturday for our junior staff. You will give the talk. I trust you will be sufficiently blunt.”
“You bet I will.” Sydney turned to go. “Thank you, Harding.” As she started to leave, Hooten called after her.
“Remember, between the idea and the reality. Between the motion and the act, falls the shadow.”
Sydney laughed. “T. S. Eliot.”
She walked out. She and Hooten shared an intense desire for perfection, and they had both been dual English–Biology majors.
Hooten picked up the phone and punched a number from memory.
“Sorry for the interruption, Morgan. You were asking me whom I’d recommend as my replacement when I retire. I think I know the perfect doctor. I’ll tell you about her the next time we meet for lunch.”
Tina was back at The Free Clinic. She’d reached the point where she looked forward to her time treating the indigent so much, she resisted returning to the hospital. She’d come to think of the Free in Free Clinic as her own freedom rather than the cost of the care she provided. Tina rationalized her time away from her paying job as the hospital underwriting care for the underserved who lived nearby. Weren’t hospitals supposed to do that anyway?
Tina wasn’t shirking at Chelsea General. She still taught medical students, went to clinic, and performed surgery, but she didn’t do anything extra. She was fulfilling her obligations…barely. And at Chelsea General, that was the exception, not the rule. Chelsea General was the place where doctors ran cutting-edge clinical tr
ials or instituted groundbreaking reforms to guard against things like hospital-acquired infections. Chelsea General was the Everest most doctors dreamed of climbing. Not for Tina. Not anymore.
Somehow, the frequent furloughs she granted herself from the hospital to work at The Free Clinic made Tina’s beauty more radiant. They seemed to relax the muscles in her face imperceptibly. The double takes she got from men and women alike during the normal course of moving through the world increased, along with her happiness. Not that she was looking for the attention. Even in the threadbare surroundings of the clinic, Tina looked glamorous in her white lab coat and heels. Standing in the small examination room, she looked more like a model on a photo shoot playing a doctor than an actual doctor peering down the throat of a child with a phlegmatic cough, which she was at that moment.
“Say ahh,” Tina instructed. Tina was just noticing the blisters along the inside of the cheeks when she heard the chime of the clinic’s front door. The child had the Coxsackie virus, better known as hand, foot, and mouth disease.
“Let me see your hands,” Tina said to the little girl, gently holding her wrists and turning them palms-up.
“Can I help you?” she heard her assistant DeShawn ask.
“I need to see a doctor.”
“Have a seat.”
“I said, I need a doctor.”
Tina stopped her examination and listened.
“Sir, could you please take a seat,” DeShawn said. “We have a first-come, first-served policy here. She’ll be out as soon as she can.”
“She. Who is this bitch? This doctor bitch.”
“Sir, please.”
The Free Clinic was small, and Tina, her young patient, and the patient’s mother could hear every word. Tina’s first thought was hostile attribution bias—the mind-set that when things didn’t go your way, it was because people were out to get you. Classic paranoia. But then Tina noticed her patient with her mouth open. She was looking at her mother, fear in her eyes. The mother didn’t know what to say. She looked at Tina. Tina flushed.
“One moment.”
Tina stepped out of the examination room to see a man about thirty-five years old standing with his arms crossed giving DeShawn the evil eye. His short brown hair looked as though he used his fingers as a comb, and he wore an old green fatigue jacket. Some sort of serpentine tattoo sprouted from beneath the neckline of a faded white T-shirt.
“Sir, can I ask you to please watch your offensive language.”
“Offensive language,” the man parroted.
“I’m a big girl. I can take it, but there are children here.”
“A big girl.” The man eyed Tina up and down. He looked like a starving man sizing up a porterhouse steak. “You are, aren’t you? I bet you can take it.”
DeShawn stood.
“Sir, I’m going to have to ask you to leave.”
The man locked in on DeShawn. He was much smaller than DeShawn but he was wiry, his jaw was set, and he looked like he wouldn’t mind taking a punch or two to get in a few of his own. DeShawn had been a bouncer at a local club, and usually that was enough to command order at The Free Clinic.
Tina stepped forward.
“I’m Dr. Ridgeway,” she said extending her hand. Her gesture seemed to catch the man off guard.
“K. C.,” the man said, almost reluctantly. He was enjoying the confrontation. He shook Tina’s hand.
“K. C., we’re going to get to you as soon as we can.”
“Forget it. I gotta go.” The man took a couple of steps toward the door. “I’ll come back when your boyfriend’s not here.”
“K. C., DeShawn is not my boyfriend. He works here.”
“You gotta boyfriend? I bet you need a boyfriend.” He sized Tina up again. “I could make you happy.”
“Mr.—K. C.—I’m a doctor here. If you’re interested in free treatment, come back.”
“I’ll come back. Count on it.”
K. C. opened the door and left.
CHAPTER 29
T
y sautéed tofu with blueberries, red peppers, pineapple, and ginger, and looked out the window of his penthouse apartment. Rain was hitting the window in sheets, blurring the lights of the buildings nearby. Ty had always enjoyed being alone. It was one reason he’d never wanted to maintain a relationship for more than a couple of months. No matter how beautiful or witty or thoughtful his companion, sooner or later, usually sooner, he began to feel suffocated. He would escape to the hospital, where he could immerse himself in his work and avoid the woman who was at that point plotting how to reform his incorrigible bachelor ways.
Ty stirred a little soy sauce into his mix, dumped it into a shallow bowl, and sat down at the glass-and-steel table by the window. As he began eating with chopsticks—Ty believed this was healthier because it prompted him to eat slower—he looked out the rain-streaked window but felt none of the sense of peace that usually accompanied these quiet dinners alone. While most people needed to turn the television on to keep themselves company, Ty liked silence. He reveled in it.
Tonight was different. Ty was on edge. He was beginning a four-day weekend to mull things over, but he had a sense of being frayed, jumpy. He walked across the room, found his remote, turned on the television, and flipped until he found a basketball game. It was a desultory early-season game pitting the Pistons against the Mavericks. He watched for a few minutes as he ate. The game was in the second quarter, and the players seemed to be going through the motions, waiting for the fourth quarter when the game mattered. He pondered a job where you could do less than your best and no one died. Most jobs were like that.
Ty got up, walked across the room, and turned off the television. His sense of peace did not return with the announcers’ patter gone, and he realized in a flash why he was edgy. Ty wasn’t really alone. His constant companion these days was his accuser, the voice in his head telling him that he was not competent, that he had been fooling himself, that he had been fooling others. That he was nothing but an imposter. The by-product of this poisonous self-judge was doubt. Ty was racked by uncertainty. How could one case trigger such a strong reaction when he had sailed through his career so far? It seemed absurd, but he had tried laughing it off, sweating it off, and waiting it out, and the doubt remained. Ty had done some research, and he found a study showing that unconsciously attempting to avoid errors actually resulted in more errors. How could you possibly eliminate unconscious thoughts? It was like being told not to think about the pink elephant. It was like a negative feedback loop. The more he tried to squelch his feelings of doubt, they more they took center stage in his thoughts.
There was another reason Ty was edgy. It had been fifteen days since he had punted on the ETBS. He hadn’t performed an operation since. He’d been to clinic and to M&M, but he had avoided the OR with a deep fear that was a new and powerful force in his life. More than two weeks. It was the longest Ty had gone without performing surgery since he’d finished his training. The residents loved the extra experience in the OR, but every day Ty stayed in town and didn’t operate, he was succumbing to his cowardice. He hated the feeling. He hadn’t gone into medicine or surgery to walk away from the tough decisions. Just the opposite.
Ty looked out the window again. The rain had subsided. The storm was heading east. He could now see the moon, flickering between fast-moving clouds scudding across the night sky. Ty had an idea. He walked over to his laptop, typed in Delta.com, and then checked his watch. He rinsed his plate and put it in the dishwasher. Then he went to his room, threw a few things in an overnight bag, and walked out the door.
Park scheduled his radiation at night. He did not like to enter the hospital during the day as a patient. In this way, he did his best to keep these two identities separate. Sung Park, the doctor. Sung Park, the patient. He knew this thinking wasn’t entirely logical. He was both doctor and patient. He knew that. Even so, each night, one of his residents would pick him up at his house and drive him to Chelsea G
eneral; because of the risk of a seizure, his insurance company didn’t want him driving. His wife offered to take him, but she was needed to run the household, get the children to bed. It was simpler this way.
In a large room dominated by a hulking radiation machine, he would lie down on the gurney, which the radiation therapist called “the couch.” She fitted Park’s custom-made plastic mesh mask over his face and clipped it down. He’d overheard a younger cancer patient refer to this as his “Jason” mask, though he didn’t know why.
The top of the so-called couch then slid out, placing him under the oculus of the machine. It looked like an eye peering down on him, but the orb wasn’t “seeing” Park. This was the source of the high-intensity X-rays. The eyes of the machine were panels that the radiation therapist called arms, which made Park think of his word-power cassettes. “Anthropomorphism: Giving human attributes to animals or nonliving things.”
With the lights dimmed, the machine pivoted around Park, whose head was pinned looking straight up. The arms recorded where the small marks on the ears, neck, and forehead of the mask were located so the radiation would be aimed precisely. Once it started, Park heard a buzzing but felt nothing. Park had, of course, prescribed post-operative radiation therapy for his patients, but he’d never given it much thought. It was simply the standard of care.
As a patient, the process was full of wonderment for Park, a literal-minded individual who made a point of believing what he could see. As the machine arced around his head, he knew cells inside his brain were receiving a three-dimensional bombardment of X-ray energy. He knew photons were damaging the DNA of cancer cells that remained after his surgery—and some healthy cells. That way they wouldn’t be able to divide. But how did he know, really? The radiation was invisible.
Immobilized on the flat gurney, Park was uncharacteristically still for a man of movement, of action and accomplishment. Stuck under the formfitting mask, his mind was liberated, free to wander, to muse. There were always things to do. Musing was something Park had considered a waste of time.