Making a decision, Benton pulled up Robert Hartley’s office number on his mobile but didn’t use it to make the call. Instead he dialed the number on his hospital landline, knowing he’d get better service from the law firm’s office help. The Mason-Dixon Medical Center was an important client.
As the call went through, Benton calmed down further. There had been some problems running the Anesthesia Department before, maybe not as big as the current fiasco, but problems nonetheless. Yet the perks he’d received from taking the job had been sweet, particularly the stock options. Their value had escalated, especially now that there was talk of a takeover of Middleton Healthcare by Sidereal Pharmaceuticals, owned by the billionaire Russian expatiate Boris Rusnak. If that happened, Benton could really retire in style.
As he expected, he was put through to Bob Hartley directly, and the lawyer picked up the phone almost before it had a chance to ring.
“What can I do for you, Benton?” Bob said. His voice was deep and reassuring. Over the years they had gotten to know each other well enough to be on a first-name basis.
“I’m afraid there’s been a breach in your directives to Dr. Wykoff. I thought you should know immediately.”
“That’s not good. What exactly happened?”
“I walked in on Dr. Wykoff having a chat about the case with a couple of fourth-year medical students. I couldn’t fucking believe it after what you said yesterday.”
“Did these medical students seek her out?”
“Yes. One of them bumped into Wykoff in the women’s locker room and asked out of the blue if she could talk about the Vandermeer case. And for some reason Wykoff agreed.”
“Do you have any idea why she agreed?”
“She says she is really upset about what happened and needed to talk about it as a kind of therapy. And get this: she said she thought of the medical students as family. Jesus Christ! Medical students. Can you fucking believe it?”
“How did the medical students hear about it? Do you know?”
“I have no idea.”
“Do you know why they are interested in the case?”
“Wykoff said they were concerned about the issue of hospital-acquired morbidity: people going into the hospital for one thing and getting something worse in the process. In that regard, I’m afraid Vandermeer is a prime example. Actually, it is a real issue.”
“Did the students mention the other two cases?”
“No, they did not.”
“Did you get their names?”
“I did. Michael Pender and Lynn Peirce. I briefly checked them out. Both are really good students in the very top of their class.”
“So they could be leaders, which might make it more of a problem. Do they have a history of being activists?”
“I have no idea, but nothing like that was suggested in either academic record.”
“Whom have you told about this?”
“You are the first.”
“I think you should tell Dr. Feinberg. The hospital president has to be aware, because if the media gets ahold of this, it could scuttle the takeover negotiations, and we certainly don’t want that to happen.”
“Of course not!”
“I assume you told the students that they are not to talk about the case with anyone, friends or family. I mean really told them.”
“I made it very clear.”
“Why is Dr. Wykoff being more of a problem than Dr. Pearlman or Dr. Roux? Those two have been extremely cooperative.”
“It is really hard to say. Believe me. It could be because it is her first major complication. Some doctors take it very personally. The one thing I can say is that she is not worried about a malpractice case. She is that confident she did nothing wrong.”
“She’s being naive. Malpractice cases can go either way, no matter what the particulars.”
“She’s also a workaholic who doesn’t socialize much and lives alone. Professionally she’s very reliable and conscientious, but something of an odd duck, at least in my estimation.”
“The other two anesthesiologists live alone, too.”
“What can I say? I don’t know why she is being uncooperative.”
“Do you think she should be terminated as a precaution after this violation of my directive?”
“I think we should wait and see how she responds from this point on,” Benton said. “She’s a damn good anesthesiologist and usually a team player. A lot depends on whether a lawsuit gets filed. But I’ll leave that decision up to Josh Feinberg. He’s being paid a fortune to deal with issues like this.”
“Sounds like a plan,” Bob said. “Thanks for letting me know. I’ll give it some thought. Something might have to be done with all these people if they don’t toe the line. I’ll talk with Josh after you clue him in. We’ll be in touch.”
With a sigh of relief, Benton replaced the receiver. He felt a lot better now that he had pushed the issue into Bob Hartley’s capable lap. Intuitively Benton knew he would feel even better after speaking with Josh, who would have no trouble making decisions about Wykoff. He also knew that Josh could talk to the dean about the students and nip that problem in the bud.
Getting up from his desk, Benton went out to his secretary and asked her to check to see if Dr. Josh Feinberg could spare a few minutes to see him right away. Benton wanted to do it before he went back up to the OR. With as many surgical cases going on as there were, he needed to be up there to put out sparks before they became fires.
A minute later Benton’s secretary leaned into his office. “Dr. Feinberg can’t see you until three P.M.”
“Okay, thanks,” he said. After getting all riled up he now felt let down. Yet what could he do? So he’d see the president at three. Until then he had other issues to deal with.
22.
Tuesday, April 7, 10:43 A.M.
Despite her exhaustion, Lynn had taken a short detour to the cafeteria. After leaving Michael she reluctantly decided that hunger had trumped her lack of sleep. The calories from the banana and bread roll she had eaten en route to the meeting with Wykoff had quickly disappeared. She felt weak, a little dizzy, and even a bit nauseous.
With little fear of running into any of her close friends, because of the derm clinic, she opted to sit down at a table. Sensing she needed some protein, she ordered scrambled eggs and wolfed them down with a cup of herbal tea. The food helped enormously, and made her believe she could think much more rationally and less emotionally. It also made her dizziness and nausea go away, something she noticed particularly as she headed over to the dorm, passing literally and figuratively in the shadow of the hulking Shapiro Institute.
Just as she had done the previous day, she paused for a few moments, eyeing the structure. She thought about Scarlett Morrison being transferred into the institute, and the idea brought up the issue of Carl being sent over as well. She questioned what she would do if that happened, as she wasn’t family. It would mean she’d be reduced to getting updates from his parents. They had been gracious when she ran into them the day before, but that could change when they remembered that she had been the one to recommend he have his surgery at the Mason-Dixon rather than the Roper Hospital at MUSC. She might be left out in the cold. Lynn shrugged. She knew she was getting way ahead of herself. With a sense of resignation, she continued toward the dorm.
It felt weird going into Michael’s room without him. After closing the door behind her, she stood for a moment, taking in the familiar sights and aroma. Michael was far neater than she, and everything was in its place. Even the books were shelved according to subject matter. Over the years she had teased him about the fastidiousness in his lifestyle, just as he had given her grief about her lack of it.
Although it was a bit strange to be in the room without Michael, just being there also felt comforting. She had spent considerable time in his room, as he had in h
ers. Especially during the first two years, they had studied a lot together in one or the other’s room. Many of the other students had preferred the library or the student center for communal learning. Not Lynn and Michael. What made studying together so rewarding was that they silently pushed each other to make greater efforts than what they would have had they studied on their own.
She sat down at Michael’s computer. He had cobbled it together from various components to maximize the gaming experience. She had gone through a gaming period herself but had grown out of it. Not so with Michael. She knew that he still used it to relieve anxiety and difficult emotions that medical school was capable of engendering, especially for a black man in a southern, mostly white professionally staffed medical center. He had admitted to her that he often gamed for fifteen minutes or so late at night, explaining that when he was a teenager, gaming had been a much-needed escape from the pressures of the ’hood, and a way of dealing with aggression.
After turning on the system, Lynn pulled up pictures. Expecting to find a well-organized and well-thought-out photo filing system as further evidence of his compulsiveness, she found something quite different. The photos were organized merely by date, meaning the chronological order in which the photos were taken.
Remembering that Ashanti had had her surgery several months earlier, Lynn started looking at photos taken in January. To her surprise, she came across a series of pictures that had been taken on a Saturday-afternoon excursion to the gorgeous Middleton Place, the apparent namesake of Middleton Healthcare, a sixty-acre landscaped garden begun as a rice plantation in the seventeenth century and now listed as a National Historic Landmark. Michael, his girlfriend, Kianna, Carl, and she had gone.
Lynn’s breath caught as she found herself looking at a photo of herself and Carl and Kianna in a horse-drawn carriage. Michael was not in the photo because he was the photographer. It was a happier time: a sublime time.
For a second Lynn closed her eyes and let the reality of Carl’s coma flood her thoughts. She had been getting by on a ton of denial and intellectualization, but now the realization that his mind and memories were gone descended on her like an avalanche. For the first time since the tragedy had begun, she let herself be enveloped by raw emotion. She began to cry. And cry she did, with shuddering intensity like a summer thunderstorm.
After what seemed like an eternity, the tears slowed. Eventually Lynn managed to get up and get some toilet paper to dry her cheeks and blot her eyelids. The small amount of makeup she used came off in a dark, dirty smudge.
Regaining a semblance of control, she went back to shuffling through Michael’s extensive photo collection, avoiding pictures of Carl and herself as much as possible. It was difficult because there were a lot. She had forgotten they had double-dated with Michael and Kianna quite so often. There were photos of all sorts of things, including hundreds of shots of Charleston historic houses.
Eventually Lynn found the image she’d been searching for and brought it up onto the screen. It was entirely readable, especially since its compression had been slight, and she was able to enlarge sections. Satisfied, she e-mailed the image to herself in a large format. She wanted to preserve her ability to look at the details, particularly his vital signs. A moment later she heard the phone in her pocket announce she’d gotten the e-mail.
Lynn was back in her room a few minutes later. She took off her white coat and draped it over the reading chair, which also contained a ball of recently washed clothes. It always took her time to sort through the bundle when she brought it up from the laundry room in the basement. Sometimes she didn’t bother. On those occasions she just used the clothes as they were needed.
For a moment Lynn eyed her bed, which she made only when she washed her sheets, which wasn’t often. She had always thought she had better use for her time. Briefly Lynn considered lying down for just a few moments. Then she changed her mind. She knew that once she was horizontal, it might be difficult to get up.
Instead she sat down at her laptop and went into her e-mail inbox. There at the top was the JPEG she’d just sent to herself. Immediately below were two other e-mails from Michael. As promised, they were Scarlett Morrison’s and Carl’s anesthesia records. Lynn checked to be sure. Then she loaded all three into a flash drive, which she would take down to the student common room on the first floor to utilize the communal printer. But before doing so, she Googled gammopathy as she had done in the neuro ICU and immediately found the same article: “Monoclonal Gammopathy of Undetermined Significance.” She downloaded a PDF version into the same USB device. Then she downloaded Wikipedia articles on multiple myeloma and serum protein electrophoresis. The last article she knew she wanted was on monoclonal antibodies, but when she rapidly read through it before downloading it, she realized there was one more she needed. It was on hybridoma technology. From an immunology lecture in her second year she remembered that monoclonal antibodies were made by hybridomas.
So armed, Lynn went down to use the printer. She had to swipe the magnetic tape on her student ID to get the machine to operate. While the machine did its thing, she sat in one of the leather club chairs and practically fell asleep.
With her printouts in hand, she went back to her room and lay down on her bed. For a few minutes she debated which of the printed pages she should read first. She thought about looking at the anesthesia records but decided she needed a completely clear head for those. Instead she turned to the articles. She settled on the gammopathy article, since it would be a review, as she had already read it once before in the neuro ICU. After that, she planned to read the one on multiple myeloma. But the reality was that she managed only four or five sentences of the first article before falling into a deep, dreamless sleep.
23.
Tuesday, April 7, 1:52 P.M.
With a sense of relief Sandra Wykoff left the PACU after making sure her second and final case was fully awake and functioning normally. It had been a hip replacement, and she was confident the patient would be going back to the fifth floor in short order. During both cases, when it came time for her to wake them up, she’d had a degree of anxiety, but both had awakened as expected, just as all the other cases she had done in her career, except for Carl Vandermeer’s.
Once out in the main hallway, Sandra walked down to check the whiteboard to make sure she had not been scheduled for another case since her first case had been canceled. Although she was confident Geraldine Montgomery, the OR supervisor, would have let her know, she wanted to be certain. After the tongue-lashing she’d suffered from Benton Rhodes that morning, she wanted to be absolutely certain she didn’t do anything to provoke the man further. She had known about his reputation for having a short fuse but until that morning had never experienced it personally.
The more Sandra thought about the Vandermeer case, the less harsh she became on herself. She was absolutely confident that she hadn’t done anything wrong during the procedure. She had not even taken so much as a shortcut, which she knew other people in the department did on occasion, particularly neglecting to manually check the anesthesia machine before each use. Most relied completely on the automatic check, which she thought was a mistake.
It had taken only a little more than an hour after Rhodes had stormed out of the communal OR anesthesia office for Sandra to be again totally convinced that whatever had happened during the Vandermeer operation was not her fault. She was absolutely sure of this, since she had, as she had told the students, gone back over the case in minute detail, questioning every step and consulting with several other anesthesiologists whose opinion she admired and trusted.
Sandra had even tried to have a conversation with Mark Pearlman, who had had a strikingly similar case the previous Friday, but he had refused to talk with her about his case or hers. He had chosen to follow Rhodes and Hartley’s orders to the letter, even to the extent of not talking to a fellow anesthesiologist. Sandra thought that was a mistake despite wha
t the hospital counsel felt. She knew that complications often led to advances in medicine.
The long and short of it was that if there was a lawsuit, Sandra was confident that no one would find the hospital or herself culpable. And, contrary to what Benton Rhodes had said, she was sure that the two students were Mason-Dixon family and could be trusted. She had made the effort to call the dean of students to ask about Lynn Peirce prior to seeing her and had learned that Miss Peirce was going to graduate number one in her class, just as Sandra had done over at MUSC almost seven years before. There had been no reason not to talk to her and her classmate and perhaps salvage something from the disaster. Students had to learn that medicine was not all-powerful or completely predictable.
And there had been a positive aspect to the conversation with the students. For Sandra, talking about the case in detail had helped ameliorate the guilt that had been haunting her since the tragedy had struck and boost her confidence in her professional abilities. Confidence was important if she was to continue being an anesthesiologist.
The other thing the conversation with the students had done was remind her of the blip that had occurred on the monitor. It had been so insignificant, but considering it was the only thing about the case that was at all unusual, she now thought it was worth checking. The problem was that doing so necessitated calling Clinical Engineering, something she was reluctant to do, since it meant risking having to deal with Misha Zotov.
Steeling herself against such a possibility, Sandra walked back down the main OR corridor whence she had come and headed for the room where the extra anesthesia machines were stored. Her hope was to corral one of the Clinical Engineering technicians and ask a few questions about the blip she’d seen on the monitor. She wasn’t looking forward to going all the way down to the Clinical Engineering Department, located in the hospital basement, where she had first encountered the irritating Russian.