“Hang!” Michael said definitively. “You can handle it, and it’s better to get it over with here in the hospital.”
Her pulse racing, Lynn watched them approach. The first to recognize her was Leanne. She was a slight woman wearing a gray, conservative suit, looking like the elementary school teacher she was. When she caught sight of Lynn, her drawn face revived from grief to concerned sympathy. Without the slightest hesitation she came directly at Lynn and enveloped her in a sustained embrace. Lynn was pleasantly surprised. Previously Leanne had never given her more than a slight kiss on the cheek.
“How are you managing, my dear?” Leanne asked, still holding on to Lynn’s arms after the lengthy hug. She was a good six inches shorter than Lynn and had to look up into her face. “Now, I want you to promise me you are going to take this bump in the road in stride. He’ll be waking up soon. Trust me! Everything is going to work out just fine. I’m sure of it. I know how busy you are. Patients are depending on you. You have to take care of yourself and get back to your work.”
Lynn glanced at Michael for support. Thanks to Carl’s descriptions, she was aware Leanne was controlling, but this seemed beyond the pale. The woman was telling her how to respond to the disaster.
“I’m so sorry for you this mild complication had to occur,” Leanne said. “But it will be over soon. I’m certain.”
“I’m sorry, too,” Lynn said. Leanne’s apparent denial of the reality of Carl’s condition was such a surprise that it made it easier for Lynn to control her emotions. Lynn had feared censure and blame but was experiencing empathy. She was both relieved and thankful.
“You must be just devastated,” Leanne continued. “Have you seen him?”
Lynn nodded, hesitant to admit she had in front of Dr. Weaver, who she thought might recognize her having done so as a violation of hospital rules, but Dr. Weaver, obviously having his own problems, didn’t respond.
“How does he seem?” Leanne asked. Her expression of concern morphed back to grief.
“Very calm,” Lynn said. “He looks like he’s asleep.”
Leanne let Lynn go, and Markus gave her a second hug. Carl’s father was a sizable man like his son but heavier boned. His face was lined and always tan. He was an inveterate golfer who loved his bourbon. In contrast to his wife, he looked thoroughly shell-shocked and chose not to speak.
“Has there been any change?” Leanne asked when Markus let her go.
“I’m afraid not,” Lynn said. She gestured to Michael. “You remember Michael Pender, of course.”
“Yes, of course,” Leanne said, briefly acknowledging Michael but immediately turning back to Lynn. “We are going to make sure that the best doctors are involved in Carl’s care. I’m sure there will be a change for the better very soon.”
“I hope so,” Lynn said, nodding her head. She looked at Dr. Weaver, who was still dressed in scrubs. He didn’t meet her gaze and encouraged the older Vandermeers to move on toward the neuro ICU, saying there was only a small window of opportunity for their visit.
After promises to get together, the Vandermeer parents continued down the hall. Lynn and Michael headed in the opposite direction toward the elevators.
“Now, that wasn’t half-bad,” Michael said.
“They were very generous,” Lynn admitted. Quickly her mind reverted to what they had been talking about before catching sight of the Vandermeers. “What were the details of that similar case you mentioned, and how did you hear about it?”
“It was an African American female in her late twenties or early thirties, generally about the same age as Carl. She was operated on with general anesthesia after being shot in both knees. She didn’t wake up. There was an episode of hypoxia just like with Carl, and that was it.”
“She was operated on here at Mason-Dixon Medical Center?”
“Yes. I’m telling you, the case was a mirror image.”
They arrived at the elevators. Lynn tugged on Michael’s coat to get him to stop. She didn’t want to talk about a case on a crowded elevator, but she wanted to hear more. “Well, how did you hear about it?”
“My mamma called me from Beaufort to tell me a distant relation was having a major complication after surgery here. She asked me to look into it, so I did.”
“What was the woman’s name?”
“Ashanti Davis.”
“What kind of relation was she to you?”
“Very distant and only by marriage. Cousin of the brother of an in-law on my mother’s side of the family or something obscure like that. I knew her a little in high school because we went to the same regional school, but she was ahead of me and never finished, and we ran in different circles.”
“Shot in the knees? Was that the result of some sort of gang war?”
“Someone had a serious beef with her—that much is clear.”
“What’s happened to her?”
“She permanently gorked out after the operation. Within days they moved her over to the Shapiro Institute.”
“That’s awful,” Lynn said. “And is she still there?”
“As far as I know. I don’t think anybody visits or asks. Nobody in her family wants to pay the kind of bread they get for room and board, if you know what I’m saying. She wasn’t very popular in her family, to put it mildly, even in her surviving immediate family. In high school she was considered a slut with a penchant for dating all the aspiring gang members. I kept my distance. She even got one of my cousins shot dead, so her getting shot wasn’t all that unexpected considering the people she ran with. She was a bad apple.”
“What an awful story,” Lynn said. “Before getting shot, was she generally healthy, like Carl?”
“As far as I know.”
Lynn shook her head. The fact that there were two healthy people at Mason-Dixon who within months of each other did not wake up from anesthesia was more than disturbing; it was downright frightening. And it was terrifying to think of Carl being transferred over to the Shapiro. After the brief visit, she and her medical-student colleagues equated it to being shipped off to Hades.
“I would love to have a look at Ashanti’s hospital record,” Lynn said.
“Whoa!” Michael said, leaning away from Lynn as if she might be contagious. “That’s the kind of thing that could get you kicked out of medical school. Carl’s chart is different, as it is an active case, with all sorts of people having access. With Ashanti, it would be a totally different ball game. You’d have to use the EMR, and you would be caught right away.”
“I wouldn’t do it myself,” Lynn said, thinking about who might be willing to get such a record for her. Earlier Dr. Scott had offered to help her, saying her office was always open. And Lynn thought about the anesthesiologist who had taken care of Carl. Maybe she would be interested, provided she wasn’t the one who administered the anesthesia to Ashanti.
“I do have a photo of her intra-operative anesthesia record someplace,” Michael said. “I took it in the neuro ICU the same way I just took Carl’s.”
“Really?” Lynn said with surprise. “Where is it? Could you find it?”
“I’ll have to look. As I recall, it’s either on my PC or on a flash drive that’s got to be someplace in my room.” As full-time scholarship students, both Michael and Lynn were expected to live in the dorm, a separate building on the medical center’s expansive campus. Most of the other fourth-year students had moved out to private apartments. Lynn had not minded remaining since it was convenient when on call to sleep in her own bed rather than in the on-call room. Besides, she had been staying at Carl’s most weekends.
“You’ll look?”
“Of course I’ll look. But not now, if that’s what you’re thinking.” Michael glanced at his watch. “We’re already late for the ophthalmology lecture. We better get our asses over to the clinic building.”
“I’m not going
to the lecture,” Lynn said in a tone that did not brook argument. “There’s no way I could sit still for an hour in my state of mind. I’m fried.”
“What are you going to do?”
“I’m going to ride my bike down to Carl’s house and try to chill.” Lynn said. “I need to read up on anesthetic complications, particularly delayed emergence, and I can do it using his PC. I’ll feel closer to him there. I might even pray a little. I’m that desperate.”
Michael looked askance at Lynn. Religion had been a frequent topic of discussion for them, especially during their third year, when they were on pediatrics, and more recently during their advanced pediatric elective. Having to deal with suffering children with cancer had made them feel there could not be a God, at least not a loving, caring God that might be swayed by prayer.
“I know,” Lynn said, anticipating what Michael was thinking. “It goes against what I said during all those late-night talks of ours, yet seeing Carl in the state he is in makes me want to cover all the bases.”
Michael nodded. He thought he understood. This episode had cast his friend emotionally adrift.
8.
Monday, April 6, 1:16 P.M.
Lynn changed out of her scrubs and put on street clothes, anger bubbling up inside her. She was furious at the anesthesiologist, at the hospital, at medicine in general, and was reminded of how she had felt after her father died. She wanted to kick the locker where her clothes had been. She wanted to break something as she combed her hair with quick, angry strokes.
The trouble was in some respects that she knew too much. If she weren’t a medical student she could have hoped he would just wake up and be fine, which was what the Vandermeers were apparently assuming. Lynn wished she could indulge in such optimism, but she couldn’t. She knew that wasn’t going to happen. The neurology resident expected the MRI to show in detail extensive laminar necrosis of the cortex, whatever the hell that was. Yet she was knowledgeable enough to know that it meant the death of a lot of cells in the part of the brain that made people human.
Translated, it meant that even if Carl were to wake up, he wasn’t going to be the same Carl. There wasn’t going to be a happy ending, no matter what. It was a lose-lose situation. For a brief second she thought that it would have been better had he died, but then she quickly amended the thought, embarrassed at its selfishness. At least now there was a glimmer of hope, no matter how unlikely. He was, after all, still alive. Maybe there could be a miracle.
Pulling on her white coat, Lynn looked back at her image in the mirror. Her lips, normally full, were compressed in a grim line. Her green eyes stared back with hostile intensity. She was now clearly in the anger stage of her grief reaction, having already abandoned the first stage of denial. She couldn’t help but feel that the American medical system had failed her again. The first time had been in relation to her father, Ned, who had been unlucky enough to have had a rare genetic blood disease called by the acronym PNH. It was one of the so-called orphan diseases that affected fewer than ten thousand patients worldwide. After almost four years of medical school, Lynn knew a lot more about the disease than she did when she was in college. She understood now how the disease destroyed red blood cells during the night. She also knew she didn’t have it and wasn’t a carrier.
In 2008, when Lynn was a sophomore at college and the recession hit, Ned had lost his job and, with it, his health insurance. The health insurance had been paying the extraordinarily high cost of the medication that was keeping him alive. Although Ned had been able to pay the premiums himself for a year, the insurance company voided the policy as soon as they could, as it was before the Affordable Care Act. That meant no lifesaving drug, which ultimately meant Ned’s death. At the time Lynn didn’t know all of these details, just that the family was in difficult economic straits. When she did learn what had happened, it helped solidify her desire to go into medicine to try to change the system, especially after learning that the exorbitantly priced drug was so much cheaper in Europe and even in Canada. Now she felt the US health-care system had come back to bite her again.
To pull herself together, Lynn splashed cold water on her face. Behind her she saw the tall figure of Dr. Scott come into the changing room and go to her locker. For a moment Lynn debated whether she should go over to talk with her and ask if she would help look into what had happened to Carl, but Lynn rapidly changed her mind. It was too soon. She recognized she didn’t know enough even to ask intelligent questions, like how often something like Carl’s case occurred around the country. At the moment all she knew was that it had happened twice at Mason-Dixon Medical Center, only a few months apart.
Instead of talking to the surgeon, Lynn concentrated on leaving before Dr. Scott happened to see her. She didn’t want to talk to her or anyone. She knew she was on thin ice emotionally, especially now that her anger was trumping her denial.
Lynn used the stairs to avoid running into anyone she knew in the elevator. Once on the ground level, she ducked through the clinic building, which provided a shortcut to the dorm. She made it a point to steer well clear of the clinical amphitheater, where the ophthalmology lecture was being held.
Emerging from the hospital confines into the glorious Charleston mid-spring sunshine, Lynn felt a modicum of relief just to be outside. With the birds singing and the warm sunshine knifing down through the flowering trees in the landscaped quadrangle of the medical center, she tried not to think. But it was an effort to keep her thoughts at bay, and it didn’t last. Off to her right was the immense hulk of the Shapiro Institute, loudly reminding her of the plight of the brain dead.
In sharp contrast to all the other buildings forming the Mason-Dixon Medical Center complex, the Shapiro Institute seemed to be only two or three stories tall. It was hard to determine, since it had almost no windows, making it appear as a monstrous rectangle of polished granite. Lots of flowering trees and shrubs were planted around its perimeter in an attempt to soften its stark lines. There was only a single, solid, blank entrance door set back under a stone arch along its facade. There had been times when Lynn and Michael were walking back from the hospital when shifts at the institute must have been changing, and they saw personnel emerge. There were never many people. Those they did see were always dressed in unique white uniforms, something akin to surgical scrubs but more stylish and form-fitting even though they were one-piece coveralls.
Stopping for a moment, Lynn stared at the building, wondering if Ashanti Davis was still there, and if she was, how she was doing. Lynn shuddered, wondering what it would be like for Carl if he were moved into the facility and whether she would be allowed to visit. She doubted she would, since she was not immediate family.
She thought back again to the single second-year official tour that she and Michael had had, along with their classmates. She clearly remembered the details of the story behind the name. It was in honor of Arnold Shapiro, a twenty-one-year-old college student from Texas, who ended up in a persistent vegetative state for fifteen years. The immediate cause of his condition was thought to have been hypoxia. His heart had stopped spontaneously and there had been a delay for an unknown period of time before he’d been resuscitated by EMTs. The case had ignited a fierce legal battle between Arnold’s divorced parents whether to maintain him indefinitely or to discontinue the feeding tube and let him die. Ironically the case became a poster for both sides of the issue. Lynn and Michael had been told that the rationale for naming the facility after Arnold Shapiro was because throughout his ordeal Arnold had received excellent care from being in the spotlight. The goal of the Shapiro Institute was to give that same level of care to anyone who needed it, whether famous or not.
Thinking of Carl possibly getting shuttered away for years made Lynn shudder again and turn away from staring at the building. Quickly she recommenced walking toward the medical school dorm. She knew she had to get a grip on herself.
The dorm room she had occ
upied from the first day she had arrived at medical school was on the fourth floor. It was small but pleasant, and most important it had an en suite bathroom. The window looked out across the Cooper River with a view of the graceful Arthur J. Ravenel Jr. Bridge arching over to Mount Pleasant. The river was wide at that point and looked more like a huge lake.
There was a framed photo of Carl on top of the bureau. Carl was laughing and holding up a pina colada, complete with a pineapple wedge, a maraschino cherry, and a miniature paper umbrella. The photo had been taken that past summer on his twenty-ninth birthday at Folly Beach, a popular nearby resort. They had rented a small but charming cottage for the weekend.
Lynn reached out and turned the photo over. It was painfully reminiscent of a different time and place. After tossing her white coat over the back of her desk chair, she changed into more appropriate biking clothes and grabbed her helmet, backpack, and sunglasses. In the backpack went her cell phone, a fresh legal tablet, and a couple of pencils. Other than her bike helmet, she didn’t need anything else, since she had gradually stocked some basic clothing and toiletries at Carl’s house.
Lynn biked due south until she could veer off onto Morrison Drive, which eventually turned into East Bay Street and finally into East Battery. It was a progressively scenic route the farther south she went, especially when she reached the historic downtown district. When she got below Broad Street, where most of the historic homes were located, she passed the area called Rainbow Row, a series of early-eighteenth-century row houses that had been built on the edge of the Cooper River. They were all painted in historically accurate pastel Caribbean colors, a legacy of the English settlers from Barbados. Lynn’s mood cheered a smidgen. Charleston was a beguilingly beautiful city.
9.
Monday, April 6, 2:05 P.M.
Michael slipped his pen into the pocket of his white coat. He had tried taking notes to keep focused, but it wasn’t working. The main problem was that the lecture wasn’t about clinical ophthalmology, as he had expected. Rather it was a tedious review of the anatomy of the eyeball and its connections to the brain. It was material Michael and his classmates had studied extensively during their first year.