by Robin Cook
The good news was that Misha Zotov wasn’t in the room. The bad news was that no one else was, either. Turning around, Sandra retraced her steps to the main desk. It seemed that if she was going to ask about the blip, she would have to go to the Clinical Engineering office, after all.
At the busy main desk, Sandra got Geraldine’s attention and told her she was leaving the floor and that if she was needed for anything, she could be texted. Geraldine gave her a thumbs-up to indicate she got the message.
After retrieving a long white lab coat from her locker in the women’s lounge, Sandra was able to put off going down to the basement, at least for the time being. Thinking about Carl Vandermeer made her want to check on the man’s status. She had gone into the neuro ICU for a quick visit the previous afternoon before leaving the hospital and also early that morning on her way in to work. Although she was aware of the MRI and CT scan results and had read the neurology residents’ notes, she couldn’t help but harbor a bit of hope that there might be a change for the better, knowing how little hypoxia he had suffered.
Once in the neuro ICU, she went directly to cubicle 8. Seeing Carl, Sandra could immediately tell there had been no change in his condition. A nurse had rolled him onto his left side so that she could wash and powder his back. Sandra shuddered at the enormity of the situation for which she, on some level, was responsible for causing. She knew that dealing with a comatose patient required almost constant care and attention. She also knew that Carl would probably need a percutaneous gastric tube. Doing so required an operation. Sandra shuddered again, wondering how she would feel if it fell to her to do the anesthesia.
“Any improvement?” Sandra asked, even though she already knew the answer.
“Oh, yeah,” the nurse said optimistically. “He’s doing okay. A few minutes ago he sneezed.”
Good grief, Sandra thought but didn’t say. The patient’s having a sneeze was such a pathetic indication that Carl was doing okay. At the same time she understood that a sneeze was a positive sign, as it meant that at least the brain stem was functioning. She glanced up at the monitor. The temperature was elevated, as it had been that morning, but everything else was normal. She then left the cubicle and headed over to the central desk. En route she noticed that Scarlett Morrison, Mark’s coma case, was gone, as her cubicle was occupied by a man named Charles Humphries.
The previous afternoon she had had a short conversation with the head nurse, Gwen Murphy, about Carl, and again Sandra sought her out. “Any change with Vandermeer?” she asked, a bit of hope against hope.
“Nope,” Gwen said. “But on the bright side he is very stable. And the infectious disease consult hasn’t found any infection to explain his elevated temperature. And the fever has come down a bit.”
Sandra looked over at the cubicle where Mark Pearlman’s case had been. “I see Scarlett Morrison is gone. Did she go out to the neuro floor?”
“Nope!” Gwen repeated. “They took her directly to the Shapiro Institute. To be honest, they don’t really have the equipment or the manpower out on the neuro floor to handle a long-term comatose patient. At the Shapiro they are specifically set up to do it.”
“Seems awfully quick,” Sandra said. “She was here only three days.”
“As stable as she was, she didn’t need to be here in the ICU,” Gwen said. “And it’s better for everyone, the patient included, and the hospital bean counters also like it. Keeping someone here in the neuro ICU is ten times more expensive than it is over there.”
“Ten times! Wow! I knew there was a difference but not that much. That’s quite a stimulus.”
“It sure is. We’re hoping Vandermeer goes, too.”
“Really?” Sandra said with dismay. “But he just got here. Maybe he is going to improve.” In her mind, sending a patient over to the Shapiro Institute meant “pulling the plug” on hope, even if hope was unrealistic.
Gwen shrugged. “Not according to the neuro residents. It’s their feeling that getting him over to the Shapiro sooner rather than later is indicated, and we surely could use the bed.”
Feeling more depressed leaving the neuro ICU than she had when she had arrived, Sandra went back to the main elevators. She squeezed into the next down car as she had run out of excuses for postponing a visit to Clinical Engineering. Although the elevator was jammed when she boarded, descending from the first floor to the basement she was the only person left. When the elevator doors opened, she paused for a moment. Then she shook her head, feeling embarrassed at her timidity. If she ran into Zotov, she would just ignore him. She thought she was acting like a teenager.
Sandra first passed the Pathology Department and the morgue, and then the Informational Technology Department, where the hospital’s servers could be seen in their air-conditioned isolation. Next to IT was the central security office, and Sandra caught a glimpse of the banks of monitors fed by cameras sprinkled all over the medical center.
As she walked, Sandra reflected on why Misha Zotov bothered her so much. He reminded her of her ex-husband, Adam Radic, in both looks and mannerisms. Both were darkly complected, tall, muscular but slender with intense, lidded eyes and heavy beards. Both were also fawning to the point of overdoing it. With Adam, time had proved it had been an elaborate act. Somehow she was certain it would be the same with Misha.
Initially, when Sandra had first met Adam at the very beginning of her residency, she had been quite taken by his flattery and attention. She also had found him exotically attractive and much more sophisticated than she, having traveled and studied around Europe. He had come to America from Serbia to do a surgical fellowship. Believing his declarations of love were sincere, Sandra had fallen in love with him. For a highly motivated doctor like herself, it helped that he was a recognized and talented surgeon.
Within less than a year after they had started dating, she and Adam were married. But after the marriage things quickly changed, especially once Adam got his green card. He became a tyrant and had beaten her severely several times. Thanks to her father’s intercession, Sandra got divorced, but not without suffering considerable trauma. For her, the issue of domestic violence had become a distinct reality.
Sandra pushed through the door into Clinical Engineering. It was a large room with service benches piled with a mixture of all manner of hospital apparatuses, from anesthesia machines to respirators. It was all neat and orderly, with tools on Peg-Boards. The noise level was moderate, with various power tools competing with a background of classical music. At a table against the back wall two men played chess.
As Sandra’s eyes swept the room she estimated that there were about fifteen people at work, all dressed in white coveralls. Most continued doing what they were doing. A few looked up. Most of them resembled Misha Zotov. There were a few blond men, but they were a distinct minority. There were no women.
To Sandra’s mild dismay, Misha Zotov was one of those who looked up, as he was at the closest service bench, working on an anesthesia machine. She caught an expression of recognition on his face, and to her chagrin he immediately put down the tool he was using, stood, and started toward her.
Sandra’s eyes quickly scanned the room again, this time looking for Fyodor Rozovsky, the department supervisor. She had met him on her previous visit. It had been he who had answered her service-related question. Unfortunately he was nowhere to be seen.
“Ah, Dr. Wykoff,” Misha said, crowding her space. It sounded as if his English had improved, but he still spoke with a distinctive Russian accent. “You look beautiful. How can I help you?”
“Where is Fyodor Rozovsky?” Sandra asked. She took a step back, avoiding eye contact with the man. By inappropriately and presumably insincerely referring to her appearance, she could tell he had not mended his ways. She wanted nothing to do with the man. She glanced around the room yet again.
“He is in his office,” Misha said. “Please! I could get h
im for you. No trouble at all.”
“Thank you, but I’ll find him myself,” Sandra said curtly, and headed off. The office was in the back. Unfortunately Misha did not get the message and tagged along, continuing to try to engage her in conversation. Whether she answered or not didn’t make a difference. He was carrying on about the weather and how beautiful it was in Charleston with all the flowers and how bad it was in his hometown in Russia this time of the year. His English vocabulary had definitely expanded.
Sandra didn’t respond. It was amazing how much the man reminded her of Adam Radic, and the memory made her skin crawl. When she got to the door to the office, Misha was still behind her. The fact that she was ignoring him had no effect on him whatsoever. He was again suggesting they have a drink together at his favorite bar on the rooftop of the Vendue Inn, saying it was a great place to watch the sunset over the Charleston skyline. Sandra knew of the bar. It had been one of Adam’s favorite hangouts, but without her.
Sandra went into Rozovsky’s office. Without breaking a step, Misha accompanied her. Inside the office were a small service bench and several desks. One was occupied by the Clinical Engineering supervisor, and the others were empty.
Before Sandra could say anything, Misha pushed past her and engaged Fyodor in an animated conversation in Russian. Fyodor peered around Misha as Misha spoke. Sandra wondered what in God’s name Misha was talking about since she’d said next to nothing to him. Finally Misha finished and stepped to the side. Fyodor stood up and gestured to the straight-back chair Misha proceeded to pull over. “Please, Dr. Wykoff, sit down.” In contrast to Misha, he spoke with very little accent, and his English was very good. “I remember you. You came down to ask how often we did routine service on the anesthesia machines.”
Sandra sat and glanced over at Misha, hoping he would leave, but he didn’t. He was content to just stand there with a kind of smirk on his face, as if he expected some favor from her for having accompanied her into Fyodor’s office. As pushy as he was, she was glad she had not run into him alone upstairs.
“I have another question,” Sandra said, directing her attention to Fyodor.
“We are at your service, Doctor,” Fyodor said. As far as Sandra was concerned, even he exuded a suggestion of insincerity that made her uncomfortable.
“There was a very unfortunate anesthesia incident yesterday . . . ,” Sandra began, but then hesitated. She felt she needed to give some background, although Rhodes’s orders about not talking about the case made her reluctant to say very much. Yet she was talking to the people responsible for the performance of the anesthesia machine she had used, and she needed to be reassured.
As if sensing her quandary, Fyodor said, “We have heard about the event from Dr. Rhodes. First, we want to reassure you that the machine you were using had been serviced appropriately and in a timely manner. All its paperwork was in order. And as soon as we heard about the event, and following Dr. Rhodes’s orders, we brought the machine back here to our service center. We went over it extensively. I can assure you that it checked out perfectly, and it is back in service. There was no problem with the machine or its monitors, and Dr. Rhodes has been informed of this.”
Sandra nodded. Fyodor’s little spiel was more than she had expected. She didn’t know that Rhodes had asked to have the machine checked by Clinical Engineering, but it made sense. Perhaps she should have asked herself, but it didn’t matter, as it had been done.
“Do you have any additional questions?” Fyodor said.
“I think that covers it,” Sandra said, and started to rise. But then she hesitated. Settling back onto her chair, she said, “There is one other thing.”
“Please,” Fyodor said agreeably. He even managed an unctuous smile.
Similar to what she had said to the two medical students, Sandra then went on to describe the jump, or blink, or blip—she really didn’t know how best to describe it to these professionals—that she had seen on the monitor when the surgeon had begun drilling into the tibia. As she spoke, she sensed from his expression that Fyodor was disbelieving that such a thing could occur. In response, Sandra said that it could actually be seen on the machine-generated anesthesia record. “It is a very small change, but it is visible. If you bring up the Vandermeer anesthesia record on your terminal, I’ll show you.”
After a quick glance between Fyodor and Misha, which included a nod from Fyodor, Misha went to the computer monitor on Fyodor’s desk, brought up the record, and then stepped aside. Sandra then took over. As she had done when she’d been with the medical students, she zoomed in on the tracing of the vital signs. She pointed to the place fifty-two minutes into the case, where all the tracings notched upward. “There,” she said, pointing. “See the vertical jump? And when it happened, the monitor blinked, which caught my attention. It made me worry I was about to lose my feeds.”
“Interesting,” Fyodor said, leaning closer to the monitor. “I see what you mean. What do you think it is?”
“You are asking me?” Sandra questioned. “I don’t know. You people are the experts. To be truthful, I’m not all that knowledgeable about electronics. I came down here to ask you.”
Fyodor sat back and looked up at Misha for a beat. “I don’t know what it could be, but it can’t be anything significant.” Then his attention went back to the monitor. “The tracings all look totally normal before and after. What do you think, Misha?” Fyodor leaned back and caught Sandra’s surprised expression and explained, “I might be the department supervisor, but Misha is our key anesthesia machine technician. We brought him from Russia specifically to work on the anesthesia machines. He did a lot of the original coding for the model that we have here at the Mason-Dixon. He is what you say in English the go-to guy.”
Sandra was impressed by this news since she thought so highly of the anesthesia machine, although it still didn’t influence her negative visceral reaction to the man.
Misha made it a point to bend over and study the image on the monitor.
“I know it is small change,” she went on to explain, “but I had never seen it before, and since the case turned out to have such a terrible outcome, I just want to make sure it has no significance. I mean, if the patient had awakened after the case, I might not even have remembered it happened. Well, maybe that’s not totally true, since it did scare me about the possibility of losing my electronic monitoring.”
“It’s not important,” Misha said. He stood back up.
“But what was it?” Sandra persisted.
“It’s just a frame offset,” Misha said. “It’s nothing. It could happen from a number of things, like . . .” He gestured with his hands in the air, struggling to express himself with his English.
“Like what?” Sandra asked.
“What you have to remember is that the machine’s computer is constantly compressing data,” Fyodor said, coming to Misha’s aid. “You have no idea how much data is being constantly generated. So seeing little changes on a monitor is not surprising. There can be blips from hardware malfunction, like one of the hundreds of capacitors prematurely discharging, or from a software problem confronting momentary input overload or even from just too many applications running at the same time.”
Sandra nodded as if she understood. She didn’t, but it was clear they did not think a frame offset had any real significance. She was about to thank them and leave when the two men suddenly launched into an animated and spirited conversation in Russian. For Sandra it was like momentarily watching a Ping-Pong game up close, her eyes darting from one man to the other. Then, as suddenly as the heated discussion had started, it stopped.
Fyodor smiled. “Sorry, it is rude for us to speak Russian. We disagree on a small issue. No matter. The important point is that whatever caused this small frame offset you noticed certainly didn’t affect the anesthesia machine’s function.” He smiled again. “Is there anything else we can help you w
ith, Doctor?”
“That’s it for the moment,” Sandra said. She stood up. “Thank you for your time.”
“We are here to serve,” Fyodor said. “Anytime you have a question, please come down or call. As you know, we have technicians available twenty-four hours, seven days a week.”
As she left the supervisor’s office, Sandra fully expected Misha to follow her. She had been mildly concerned about getting away from him, the way he had glommed onto her when she had first arrived. To her surprise and relief, he stayed inside the office with Fyodor.
Heading back to the elevators, Sandra thought she would go back up to the OR and see what she had been assigned for the following morning. If any of them were inpatients, she would go check them out. She would review the nascent electronic medical record for the ones having same-day surgery to get an idea of what the day would be like. The episode with Carl was making her more compulsive than ever. When she finished all that, she would head for home.
24.
Tuesday, April 7, 2:41 P.M.
For a few minutes after Dr. Sandra Wykoff had left, silence reigned in the Clinical Engineering supervisor’s office. The only noise came from out in the service area and was the muted whine of various electric tools combined with a hint of classical symphonic music. The two Russian expats regarded each other while immersed in their own thoughts. Both were not happy, but for slightly different reasons.
Fyodor Rozovsky had been in Charleston for several years before he had recruited Misha Zotov. The men had known each other since childhood, having both grown up in Saint Petersburg. Also, both of them had attended the Moscow Institute of Physics and Technology. Fyodor had been brought to America almost a decade earlier, when Sidereal Pharmaceuticals had agreed to fund the Shapiro Institute. With Fyodor’s knowledge of computer coding and robotics, he had been clearly essential to the project’s success. His contributions had been such that after the Shapiro was successfully up and running, Middleton Healthcare happily offered him the opportunity to run Clinical Engineering for the entire medical center. The company felt that progressive automation was key for hospital-based medicine.