by Sanjay Gupta
“Um so, Mrs. Gonsalves, do you like to cook?” Kauffman asked. Torres looked at him as though he’d lost his mind.
“Yes,” Gonsalves croaked.
“You make linguica, chorizo?”
Here, Gonsalves offered an approximation of a smile. “Yes,” she said again.
“Thanks.”
Kauffman left the room. A bewildered Torres followed.
“Trichinosis,” Um-So said. “See the cut on her finger. My mother used to cut herself like that all the time cooking. Um so, she must have tasted the seasoning on the raw pork when she was cooking.” Worms from the raw meat had infected her body. Villanueva stood outside the room and smiled as Kauffman and Torres walked. He raised his eyebrows, as if to say See, I told you he would figure it out. Suddenly three shrills went off in rapid sequence. All three doctors reached for their pagers, and they all saw an unfamiliar number on the screen.
It was almost dark when Tina closed the front door of The Free Clinic and locked the deadbolt. She was alone. Usually, she and DeShawn walked out together, but he had left early because his twelve-year-old daughter was sick in bed with a fever. His wife worked a night shift at an Ann Arbor hotel as a front desk clerk, and the girl, Alisha, spent an hour alone most days between the time her mother left for work and her father got home. On this night, Tina insisted DeShawn be with his sick daughter.
Tina was putting the keys in her purse when the punch hit her left eye. She didn’t know it was a punch. She felt as though something inside her head exploded. She turned and saw a familiar-looking man wearing a green fatigue jacket. “Told you I would be back, bitch,” she heard. She blacked out before she hit the sidewalk. She didn’t feel the second blow or the third or any of the other punches and kicks that followed. She didn’t feel the baseball bat hitting her in the head or the chest or the abdomen.
Michelle had packed her bags and loaded her car to the ceiling with her belongings. Anything that didn’t fit—the ficus tree, the coatrack—she simply gave away. She planned to drive straight through, from Michigan to Louisiana. Mapquest said the trip would take eighteen and a half hours. She was hoping to cut some time off that. Still, she thought her resident training would come in handy. She was accustomed to staying up all night on caffeine and adrenaline. Caffeine was no problem. She had a large thermos of chicory coffee made for the trip. The adrenaline might be in short supply. She expected a long, boring drive through the night as she headed south toward Fort Wayne, Indiana, then west toward St. Louis before pointing the car south and passing through Missouri, Arkansas, Tennessee, Mississippi, and finally entering Louisiana. She prepared for the mind-numbing twelve-hundred-mile trip by lining up her favorite Cajun CDs on the visor on her old Civic. She planned to sing along at the top of her lungs as much as possible. Anything but think about what had happened at Chelsea General and what would happen in the weeks and months ahead.
Michelle had almost reached the on-ramp to I-94 when she was nagged by a piece of unfinished business and turned the car around.
Ten minutes later, she slowed outside The Free Clinic. Too late, she thought when she saw the lights out in the picture window. She was about to leave when she noticed the body lying in front of clinic. It looked as though a homeless person had simply passed out by the front door. Michelle was about to pull away when an alarm in her brain went off. Something about the picture wasn’t right, but she couldn’t immediately figure it out. She scanned again, and figured it was just somebody sleeping off a bender waiting for the clinic to open in the morning. Then her breath caught in her throat. High-heeled shoes. She recognized them. She had, in fact, coveted them from afar, for their elegance and the regal bearing of their wearer.
Michelle pulled over and stopped the car. She ran to the unmoving form without closing the driver’s door.
“Sweet Jesus,” Michelle said out loud.
If she hadn’t known who it was, Michelle would not have recognized her mentor, her lone supporter at Chelsea General when her residency hit the rocks. Tina’s face was battered beyond recognition. Her eyes were swollen shut. Her lips were cracked and bleeding. Her nose had been broken. That was simply what Michelle could see. She checked for vitals. Tina’s chest wasn’t rising, and Michelle could tell several ribs were broken. A check for a pulse revealed nothing. Michelle pulled out her cell phone and called 911, put it on speaker, and immediately started chest compressions.
The paramedics arrived in the Emergency Department with Michelle walking behind the gurney. The entire staff seemed to be waiting in the trauma bay. Some were crying, and there was an audible gasp as people caught their first glimpse of a lifeless Tina Ridgeway. Villanueva marched into the foreground. The sight of his friend and colleague hit him like a punch. He hesitated momentarily, then went to work. He removed the trauma blankets covering Tina and hollered “Seven!” The gurney was quickly rolled in. Sanford and Tran came running in, followed in hot pursuit by Ty. “Tina…is that really Tina?” Ty asked no one in particular. He began to weep. McManus and Saxena ran into the ER, still dressed from their romantic dinner. “What happened?” Saxena shouted. Soon, everyone was jockeying for position, with all of Chelsea’s finest working shoulder-to-shoulder trying to save one of their own. Hooten received a call at home and immediately returned to the hospital. He was the one to take Tina’s husband, Mark, and their daughters into a private room to tell them what happened. Mark’s sobs could be heard throughout the waiting room.
“The good news,” Hooten told them, “is Tina is alive.” Other than that, the news was grim. She had lost a lot of blood and had terrible injuries to her head. She had lost several of her teeth. Her jaw was broken. The orbit beneath one of her eyes was broken, as were several of her ribs. Her kidney was bruised. The worst news of all was that she had a severe brain injury. The trauma from the fall or possibly a kick in the head was causing her brain to swell. Villanueva and Ty had decided to induce a coma to slow the swelling and give poor Tina’s brain a chance to recover. Villanueva sedated her and placed her under a special blanket to begin cooling her body. Ty collected himself, prepped the operating room, and was standing by ready for action, but everyone recognized that this type of brain injury wouldn’t benefit from surgery. She could only heal on her own. It would be days before they’d know if Tina would survive and whether she had sustained any permanent brain damage in the attack.
CHAPTER 44
M
aybe Harding Hooten should have taken a page out of Ty Wilson’s playbook and done some deep breathing and meditation before he headed into the OR, but the case was an emergency. Maybe he shouldn’t have scheduled the meeting in his office while he was covering the OR, but truth be told the get-together went far beyond its allotted time and the chance of a neurosurgical emergency requiring his presence was slim. Maybe he should have let a resident take the case. Maybe he should have checked the film one more time. Maybe he should have realized how much Tina’s case was affecting him. Or how much stress he felt by firing Michelle Robidaux.
Eaton Lake was a friend, or, more accurately, their wives were. The women served together on a number of boards: the zoo board, the opera, the Alzheimer’s association. Harding and Eaton had shared more than a few nights together at black-tie fund-raisers their wives had helped organize. Now Eaton wanted to make a real name for himself in Michigan’s philanthropic community, and he went to see Hooten first. This was a huge opportunity for the hospital. When the doctor heard how much wealth Eaton had accumulated handling mergers and acquisitions, he was stunned. Eaton said he had $150 million—“give or take”—to give to the hospital. Maybe the knowledge that this man was so much wealthier than Hooten had ever imagined threw the doctor’s internal compass off its usual meticulous setting.
Eaton’s mother, like his wife’s mother, had died of complications from Alzheimer’s. Now he and his wife wanted to give money to the hospital to set up a center for Alzheimer’s research and name it after their mothers: Susan Lake and Delores Costello. H
ooten was telling Eaton his money could do more. They could broaden it to include Parkinson’s and other degenerative brain diseases striking the elderly. Maybe Hooten should have simply congratulated Eaton on his generosity and put him in touch with the hospital’s fund-raising folks, the smooth-talking, suit-wearing cadre who talked about “charitable remainder trusts” and other philanthropic incantations. He didn’t.
Harding and Eaton were talking about their respective legacies the way they had talked about the relative merits of Glenlivet and Glenfiddich at one of the fund-raisers when the doctor’s pager went off. Hooten did not have hundreds of millions of dollars, far from it, but he, too, was concerned about his legacy. At the end of the day, what did you have to show for a career? A brand-new building honoring your mother was something solid, concrete and glass, with ongoing research that could make its mark on medicine. Hooten had helped train hundreds of surgeons. They were his legacy, a sort of professional progeny far more amorphous than a building. That and his good name, synonymous with an exacting attention to detail and a commitment to the best surgical practices. Maybe he should have remembered that before he rushed from his office for the OR. He didn’t. He was thinking he was too old and too senior to be hopping to every time someone in the OR got antsy.
An illegal immigrant had come to the emergency room from one of the glitzier suburbs, brought by a woman still in her high-end tennis outfit. To save a few bucks, she had picked him up after practice from among the milling day laborers outside the big-box home improvement store. He was standing on her ladder, scooping leaves out her gutter, when he leaned too far and fell. His feet had apparently hit the boxwoods, flipping him backward. His head hit the patio flagstones, knocking him unconscious. The woman had driven the man to Chelsea General. Henry Ford was closer, but she apparently thought all indigent cases went to Chelsea General. Also, she thought St. Joseph’s was too close to home. That’s where she went. Day laborers went to Chelsea General.
A scan in the OR revealed a large blood collection on one side of the man’s head. Hooten couldn’t believe it. Here he was talking to a man about a gift that could transform Chelsea General and, with some luck, make a major breakthrough in some of the most heartbreaking neurological diseases—and he was called out to serve as the surgical equivalent of a glorified can opener. Hooten excused himself and spent ten minutes without success trying to find another neurosurgeon to do the operation.
“Eaton, I’d really like to continue our conversation. Can I talk you into relaxing up here for about twenty minutes. I’ve got a quick case.”
“Sure thing, Harding. If I can convince your secretary to find me a cup of coffee. Can’t go an hour without a caffeine fix. Terrible.”
Hooten stepped into the large bathroom connected to his office and changed into his scrubs. He walked fast to the OR, still irked that he had to leave Eaton Lake hanging in his office while he had to handle this mindless case.
When he arrived at the OR, the anesthesiologists had already inserted a breathing tube and were patiently giving anesthesia. Hooten took a quick look at the scan, grabbed a razor, and began shaving the left side of John Doe’s head, or, as the circulating nurse called him, Juan Doe. No time for a shaveless operation this time, he thought. Satisfied, Hooten told the nurse to prep the head. He stepped out of the OR to wash his hands.
A pair of vascular surgeons were walking by.
“Hooten, what a surprise.”
“Didn’t think you could find the OR without a guide.”
“I can’t believe you’re not wearing a tie with those scrubs.”
“I didn’t realize it was comedy hour at Chelsea General,” Hooten said as calmly as possible. He didn’t want to let on that their gibes got under his skin this time, although he knew full well that the OR was its own universe. The normal protocol and pecking orders were set aside. It was the great equalizer. Status didn’t matter. What counted were hard work and good technical skills.
Hooten worked quickly, cutting the skin and removing the bone. As soon as the bone came off, Hooten knew something was terribly wrong. The brain looked perfectly fine. No blood. No swelling. Nothing. Hooten began to panic. He ran over to the light box.
“These scans. They’re up backward!”
“Most doctors check the scan themselves,” the circulating nurse said.
Hooten was breathing rapidly, almost hyperventilating. He felt as though he might go vasovagal any second and keel over. This could not be happening. The chief of surgery had just committed a cardinal sin. The cardinal sin. He had operated on the wrong side of the head.
Hooten rushed back to the patient and started putting the bone back. He was shaking. He needed to flip the man as quickly as possible and remove the blood, but he had lost precious time, time that would cost the man dearly.
CHAPTER 45
T
he Karmann Ghia had seemed like a good idea when Villanueva handed over a cashier’s check for fifty-five hundred dollars. He figured the vintage roadster would be a chick magnet for Nick. The kid needs to get laid, Villanueva thought. Standing behind the car, getting ready to give it another push, the big man was having second thoughts.
“When I say go, you pop the clutch and give it some gas.”
“Okay, Dad,” Nick said.
Villanueva had come up with the idea for the car in a flash and found an advertisement in the Detroit Free Press classifieds: 1971 Karmann Ghia. Mint Condition. Low Miles. A friend growing up, Eric Ramirez, had a Karmann Ghia, a red one, and he got more ass than a toilet seat. Villanueva borrowed it once, but he just looked like Magilla Gorilla squeezed into the low-slung roadster.
Villanueva was smitten with the little car the moment he laid eyes on it. It was a shade of green no company would dare paint a car anymore. The man selling the car called it “Willow Green” as he ran a loving hand along the roofline. Looked more like the color of the kitchen linoleum in the apartment he grew up in. Also, the car had wood paneling on the inside.
Even after Villanueva said he’d buy the car, the seller needed to spend another twenty minutes talking about how the upholstery was original and how much work it took to get the original paint color restored with rubbing compound, polishing compound, and wax. The man lived in a small ranch house west of Detroit. Villanueva didn’t even know where the town was until he Mapquested it. Then he called a cab to take him there, so he could drive the car home.
The seller was in his late fifties. He wore jeans and a flannel shirt and had a twitch in his left eye behind a thick set of glasses. He looked as though he had shaved for Villanueva’s visit but missed a spot just below his jawline, leaving a small line of gray whiskers alongside the raw skin. Also, the man couldn’t take his hands off the car. He stroked it like a beloved pet. Villanueva almost asked the guy why he was selling the car if he loved it so much, but he figured that would be inviting at least a thirty-minute sob story, and the last thing in the world he wanted was to see this man cry. He wanted to buy the car and be gone. Villanueva couldn’t wait to see the look in Nick’s eyes when he handed his son the keys. When Villanueva gave him the cashier’s check for the asking price, the man took the check almost reluctantly.
Nick’s reaction had been everything Villanueva had hoped for. The soon-to-be-sixteen-year-old lit up at the sight of the car even before learning that it was his. Of course, he only had a learner’s permit and would have to wait several months before he could drive it legally without an adult along. Now, though, less than an hour after George gave Nick his first lesson on driving a stick, the engine was no longing turning over. George knew if he could just get the car moving, he could have Nick release the clutch, and the car would start. “We’re going to give you a lesson on how to pop the clutch,” George told his son cheerfully.
The Big Cat didn’t give a second thought to who should be pushing and who should be sitting in the driver’s seat. The first couple of times, Villanueva had leaned his enormous bulk onto the low trunk of the Karmann Gh
ia to get it moving, Nick had popped the clutch but forgotten to give the car any gas. It had chugged once or twice and died.
Now Villanueva churned his legs again, picking up speed. He enjoyed the sensation of the little car giving way to his force. He felt as though he were twenty years old again and pushing a blocking sled at Michigan, his fellow linemen at his side, the offensive line coach riding the sled and exhorting them to work harder. Villanueva’s enormous legs moved faster and faster over the asphalt, and Nick popped the clutch and hit the gas. The roadster coughed and jerked forward.
Even as he saw the car sputter away in a cloud of exhaust, Villanueva started to feel pressure in his left arm and his chest. The crushing pain of the heart attack came on so suddenly his brain was tricked into thinking Nick must have put the car in reverse and hit him. It was worse than any forearm shiver. Worse than lying at the bottom of a goal-line pileup. As Nick drove off, oblivious to the catastrophe unfolding behind him, the big man stumbled and fell, facedown, his right fist balled up. Villanueva did not hear his son return, or his frantic exhortations for him to wake up, or the hysterical call to 911, or the arrival of the paramedics, who tried to jump-start him the way he and his son had attempted to jump-start the car. He did not hear the wail of the ambulance as his massive, prone form sped toward Chelsea General, nor did he hear the wail of his son in the emergency room when he was pronounced.