by Sanjay Gupta
Tina rolled over and faced away from her husband, but despite her fatigue she could not find sleep. She thought about the headline from that night’s transgression: “Respected Doctor Guilty of Adultery.” Or, “Married Mother of Three Seduces Doctor.” She lay there for a few more minutes stewing in her thoughts. Finally unwilling to lie there another minute longer, she got out of bed, went to the kitchen, and started the coffee machine. A hint of purple was visible behind the trees at the far end of their small backyard.
As the coffee gurgled, Tina thought of the time when she was five or six. She, her brother, and her parents had gone to the Dukes County Agricultural Fair, the highlight of the summer on Martha’s Vineyard. Wandering among the quilts and pies and artwork inside the old Grange Hall, she had become separated from her family. She went outside, thinking maybe they were ahead of her. In growing panic, she walked aimlessly among the dirt and straw and the fast-moving swirl of the crowd, a churning maelstrom of legs and feet from her vantage point. Day was giving way to night, and Tina watched a girl her own age getting lemonade squeezed from lemons and shaken with sugar and water. She walked some more, her panic growing. She walked down a corridor of carnival games and food and was distracted by the blinking lights around a booth in which you threw darts and tried to pop balloons to win stuffed animals. Darts were arranged in threes on the counter in front of the game, and enormous stuffed animals were tacked to the wall on either side of the bright balloons. The carnie running the game had leaned over the counter, his weathered, tanned face close, blocking her path. “Are you lost?” he leered.
Tina had backed away from the cigarette breath, her heart pounding, and bumped into a teenage boy.
“Watch it.”
She spun around. It was now dark, the lights from the Tilt-A-Whirl spinning around in front of her. Kids screaming. The fairgoers were silhouettes among the brightly lighted rides and games. At that moment, she was certain she would never see her family again. Tears came to her eyes. She was terrified. She stopped moving and stood as people walked past.
That’s when she heard her father’s distinctive whistle, an up-and-down, almost whimsical sound he used at the beach when he wanted them to come. She found him and wrapped her arms around his legs.
“Daddy!”
“Heya, monkey.”
Tina could always count on her father to rescue her when she was lost. Tina adored her father. She picked up the phone and called. He answered on the first ring.
“Hi, Dad.”
“Hi, Tina. Kind of early for you academic docs, isn’t it?” Tina’s father liked to chide her about her life in a teaching hospital, though his ribbing was filled with pride. He acted as though he himself had not spent most of his career in academic medicine before taking over his father’s practice in Vermont in his sixties.
“Just wanted to see how it’s going up there.”
“Got our first big snow. You know what that means. Big business. Broken ribs. Heart attacks. Sprained knees. But it is beautiful. What are you doing calling so early?”
“Just wanted to see how you’re doing.”
“Anytime you want to help out the old man, we’ll stick your name on the shingle. Ridgeway and Ridgeway, Practitioners of the Ancient Healing Arts.”
“Sounds good.”
“I’m serious, monkey. Anytime.”
“Thanks, Dad.”
Tina said good-bye and imagined herself for a moment in rural Vermont, bringing patients into the world and seeing them out. Serving as ob-gyn, family practitioner, urologist, oncologist, and every other stripe of medicine. The image seemed attractive. For all the professional prestige that came with working at a large teaching hospital, Tina admired the country doctors who often had only themselves and their medical knowledge to rely on in an emergency.
She wondered for a moment what her father would think about her scrapping her career at Chelsea General. She was angry with herself for even raising the question. Her father had always been a towering figure. She admired him, but at the same time she was growing to realize just how much control he had exerted on her path through life. Once her brother had strayed from the expectation he would become a doctor, it had been a foregone conclusion that Tina would become an MD and go into academic medicine. No doubt, she chose her own specialty, but the rest was preordained. Tina was thinking about this when she heard the rest of the family begin to stir.
CHAPTER 36
A
t that moment, Harding Hooten stood on his back deck and listened. Nothing thrilled him like the dawn chorus. He heard cardinals, a mourning dove, the rapid-fire knocking of a woodpecker. Was that a bluebird he heard? Hooten enjoyed a deep satisfaction from birding, though he had little time for it. This quiet moment before dawn was about all he could count on, and that meant listening, not watching.
Hooten’s fascination with birds began as a medical student, when a fellow first-year at Columbia had approached him and asked if he was “a birder.” Hooten paused for a moment trying to grasp the man’s name from his memory. The fellow had looked somewhat like a stork himself. What was his damn name? Hooten dug hard. He was doing this more often lately, trying to remember a name, an address, a fact from his life. He had taken to stopping what he was doing until he found the neuronal pathway that gave him his answer, but it was getting harder.
Hooten pictured his former classmate, six-foot-six, spindly, bushy eyebrows. He even remembered what he was wearing that morning: blue work pants and a denim shirt. Same thing he wore every day they went out. Hooten saw him leaning close to patients, listening with his head cocked to the side, not missing a word as he took histories. His expressive eyes always seemed damp, as though from tears or glee. He was empathy personified. Amazing bedside manner. The switch flipped for Hooten.
Scott. That was his name: Clinton Scott. Hooten breathed a sigh of relief. Maybe he wasn’t senile just yet. They called him Great Scott because patients would confess all sorts of dark secrets—drinking problems, domestic violence, even sexual troubles decades before erectile dysfunction became an acronym tossed around by athletic men on television commercials. Hooten breathed a sigh of relief. Clinton Scott. He dreaded the continuing march of age-related memory loss.
That fall morning in Upper Manhattan almost fifty years earlier, Scott had asked him if he was a birder.
“You mean a bird-watcher?” Hooten replied. Growing up in Camden, Maine, he had never given birds a second thought, other than to note that seagulls would eat almost anything they could choke down their gullets. A friend of his had worked at a doughnut shop and would lob unsold crullers at the birds, which would catch them and swallow them in stages like a sword swallower at a traveling carnival.
“I’ll take that as a no,” Scott said and handed him a pair of binoculars. “Let’s go.”
“But this is New York.”
“Central Park is a wonderful place, but we want to be there when the sun comes up.”
Hooten was tired. He had been up memorizing the bones of the hand, but Scott’s enthusiasm was infectious. From that morning on, Hooten was a birder. On mornings he wasn’t at the hospital, he went out with Scott. The outings were a reminder there was a world outside the hospital. Hooten found the serenity of watching and listening relaxing, even amid the long, long hours of residency.
Scott had gone on to become an endocrinologist and eventually head the Universidad de Ciencias Médicas in Costa Rica, no doubt attracted to the job because of the incredible diversity of bird life in that small Central American country. There were more species there than in all of the United States. At the last reunion, he’d heard Scott, one of his only true friends, had been killed in a car accident.
Hooten closed his eyes, listening, separating the cacophony of birdsongs into the different species. Even in the dark, the birds could communicate. It was a natural marvel, but on this morning, the ornithological orchestra did not soothe him. The peace he usually felt from the birdsongs did not last long. He was th
inking of the upcoming M&M. An appalling lack of communication had almost resulted in the death of a child, and Hooten had decided he was not going to let this sort of benign neglect pass without making a few of his junior colleagues sweat. A patient who dies in the OR despite a surgeon’s best efforts was one thing, but passing the buck while a child’s condition deteriorated was something he was not going to tolerate as long he was chief of surgery.
There was something else troubling Hooten this morning. He knew Martha wanted him to retire, to spend more time with her, with the children and grandchildren, to spend time at the place on Mackinac Island. But at the end of the day, what was his legacy? How could his stamp on Chelsea General be made lasting? The hospital might commission a portrait and hang his likeness in some corridor, or name a teaching service after him, but day to day how could his time at Chelsea General be measured?
Hooten had worked hard during his thirty-odd years at Chelsea General. As chief of surgery, he had routinely put in fourteen- or sixteen-hour days as chief of surgery. He had done his best to make sure Chelsea General adopted the latest surgical techniques, that every surgeon under him paid attention to details, and that residents received the best training possible. Maybe most important, he ran M&M in a way designed to make every surgeon 100 percent accountable, and as a result had transformed the very way surgeons learned and benefited from one another’s mistakes. Hooten had added a level of transparency to surgery rarely seen anywhere in the world. Still, his eyes clouded. The girl’s case showed that despite the best practices, medicine fell to individuals, who too often were inclined to push their work on to the next physician or the next shift as a result of laziness, or fatigue, or lack of confidence, or dinner plans. Even on his watch, the patient sometimes got shortchanged. The doctors, nurses, lab techs, pharmacists, therapists, social workers, orderlies inside the hospital who turned the institution from a large hodgepodge of buildings to a living, breathing organism were too often prone to the second law of thermodynamics: entropy—the tendency of disorder to increase over time. Between the motion and the act falls the shadow. Hooten’s job was to prevent the shadow, to reverse the natural trend toward disorder, slothfulness, fuzzy thinking, shortcuts, and sloppy assumptions. He did not want his tenure at Chelsea General to end with a whimper. How was it possible to have his exacting standards last longer at the hospital than he did?
In the early glow of the day, Hooten watched a female cardinal perched on a branch, its coloring just starting to show tan-green. If Chelsea General was the sum total of the individuals, Hooten thought, then the only way the hospital maintained its high standards was to make sure the individual who took his place held the same standards he did. His replacement couldn’t worry about being popular and had to be equally immune to flattery and intimidation.
For years, Hooten had thought Buck Tierney might be right for the job. He was well connected, and that could only help the hospital as it competed for the big-dollar treatment centers. Also, Tierney’s ego was so big he didn’t seem to worry much about what others thought of him. But Hooten was rethinking his reasoning. He had seen in Sydney Saxena a tenacity and the kind of unyielding standards that could make her the perfect person. She was young, not even forty. Hooten had been almost fifty when he took the job, replacing the legendary Julian Hoff. But Saxena had the right mind-set. She was driven to do the right thing and demanded excellence from everyone around her. She would not stand for shoddy medicine. Put her in place now, and she could keep the Department of Surgery in line for years. Now all he had to do was figure out how to overcome the resistance of folks like the CEO, Morgan Smith, who was vocally supportive of Tierney, and others on the board. Hooten was not naive. He knew the fact that Saxena was both young and a woman might hurt her chances among some of the old guard. Still, he knew she was the right person for the job.
CHAPTER 37
T
y walked through Chelsea General feeling as though he suffered from a sort of hangover. He hadn’t been drinking, but his synapses seemed to be producing the same sort of disjointed, unfocused thoughts. He was unable to concentrate on anything for more than a minute or two. This, from a surgeon who was accustomed to performing intricate operations lasting eight hours or more.
Weighing on Ty’s consciousness, first and foremost, was the death of Quinn McDaniel. Unless Ty was fully engaged on something else, the dead boy seemed to intrude on his thoughts hourly. Ty tried to make light of this, thinking of these thoughts as the boy’s ghost. It didn’t help. He could see Quinn looking up at him as he operated. He could see the trust in the boy’s eyes.
Then there was Quinn McDaniel’s mother. Ty’s meeting with her at the diner had been unfulfilling. He wasn’t sure what he wanted from the first meeting, but he itched to see her again. Ty reasoned that he needed to know why before he ventured down that path a second time. Wasn’t his presence salt in the wound for this grieving mother?
Finally, there was Tina Ridgeway. She was a friend and confidante. Her support in the previous weeks had kept him from becoming more unmoored than he already felt. And then there were the rendezvous. Their after-hours meetings offered the kind of distraction that banished Quinn McDaniel for the hours they shared.
Beneath her opalescent beauty, though, Ty sensed a longing not unlike his own. A desire to escape, at least for a little while. And this, too, was unsettling for Ty. She was a married woman, which held the potential for emotional carnage beyond the two of them. She had a husband and children.
As his brain seemed to shuttle between these topics, none of them resolved or even fully scrutinized, Ty wound clockwise up the concrete fire stairs toward his small office in Neurosurgery. He hardly ever took an elevator. His brain was so scattered, he had to stop to check what floor he was on. He was three floors short.
Ty continued up. He didn’t hear a fire door above closing and almost bumped into Tina coming down the stairs.
“Ty! Good morning,” she said.
“Tina?”
“Are you all right?” She stood a step above him, on the landing next to a fire door. Her voice held genuine concern.
“Just surprised. Didn’t expect to see you.”
“Are you avoiding me?”
“No. No. That’s not it at all,” Ty said. “Just thought I was the only one who took the stairs.”
“I only take them down,” Tina confessed.
They stood in silence for a moment. Ty saw something in Tina in that moment. A hard look behind the classic beauty.
“Ty, last night was my idea, and I thoroughly enjoyed it,” Tina said quietly. Her soft voice resonated in the stairwell.
“I did, too, but—”
Tina held up a hand.
“Let me finish. You don’t have to feel guilty about it. I’ve enjoyed our—” Tina paused. “I’ve enjoyed our, uh—special times together. But it’s not going to happen again.”
“You’re right. I was being selfish. You’re married. That’s bad karma.”
Tina waved off this line of thinking.
“I don’t worry about karma anymore. I used to. I used to think growing up privileged as I did, karma was stacked against me. I tiptoed through life, waiting for the karma to even out. Then Ashley was born. And I realized things are going to happen in our lives, and it’s egotistical to think we’re responsible.” Tina spoke as though the words were spilling out. “Daughters have cerebral palsy. Marriages go sour. But to think a divine being is up there with a scorecard.” Tina scoffed. “Bad things happen—”
“—to good people,” Ty finished.
“Yes. Right. Anyway,” Tina continued. “I’m not worrying about anyone’s expectations anymore. I’ve been living the life others have expected of me. That’s over. I’m going to live a life I can be proud of. I am going to be true to myself.”
Ty found the look of determination on Tina’s face slightly unsettling. She looked as though she had made some sort of major decision.
“Is there anything I ca
n do?” Ty asked.
“You’ve done enough.” She leaned over and kissed him on the forehead. She turned to go and stopped.
“Ty, I know you’ve been…” Tina paused searching for the right word. “Deeply troubled by the boy who died on the table. You’ve got to forgive yourself and move on. This hospital needs your skills.”
Park stood at the bedside of Jordan Malchus, an arc of doctors around the bed. Park had ignored Hooten’s advice to take time off, although he was now working about four hours a day instead of the fourteen that had been typical prior to his operation. The pull of medicine remained too strong for him to simply do nothing, which was how he considered staying home. And the chance to present at grand rounds was too good to pass up. Park loved the thrill of medical mysteries, and this man’s case certainly qualified as one. Put simply, weak or not, Jordan Malchus’s case was too interesting to ignore.
As Park spoke to the group, the man in the bed ignored them, and doodled on a small pad of paper as though someone was timing him. Those standing closest to him could see small shapes emerging on the white paper, one after another: ears. Each one beautifully rendered, anatomically perfect, yet each somehow conveying a different feeling. Sydney Saxena and Bill McManus stood next to each other a little farther back. Sydney couldn’t make out what the shapes were. She figured the patient was nervous at being the center of attention and was scribbling random doodles on the pad.
“Mr. Malchus is a fifty-six-year-old with no prior relevant history who suffered a pair of aneurysms. The bleeds were clipped surgically. Subsequent angiogram was clear.”