“Yes, of course. You’re singing was perfect.” Rob felt the beginnings of a lump growing in his throat. “I got video of it all,” he said, patting the phone on his hip.
Jessica, all smiles, danced lightly back to her seat.
Rob turned to his son, who wore a sullen expression. “The band was awesome too, Steven. You’re really coming along with that trumpet.”
“I messed up a note on the solo.”
“I didn’t notice—I doubt anyone else did, either.”
“I did better at the band concert.”
“Yeah, your mother told me how well you did.” Rob looked down again. “Sorry I missed that one.” The next bite of chili didn’t go down so easily. The lump was growing.
“Anyone up for a movie?” Cindy asked. “We could take our food down to the family room. I know it’s late, but it might be nice.”
Steven brightened at this idea. “Talladega Nights?”
“The Will Ferrell one?” Rob asked.
“Yeah. He’s so crazy-funny,” Steven said.
“So stupid and crude, you mean,” Jessica said, wrinkling her nose. But then she jumped out of her chair again. “I’m up for it.”
All of them giggled.
Cindy was smiling at him. Rob finally met her eyes and smiled back. She reached under the table and squeezed his hand.
Later, in bed, Rob had tossed and turned endlessly. Between thinking of his family and Gwen, wrestling with enormous guilt and temptation, and playing frickin’ cosmic Russian roulette again, he didn’t get much sleep.
Sunday morning he got up early and, despite the lack of sleep and physical exhaustion, he was in better spirits than he had been in a while. He felt like something had changed, as if a fever had broken during the night. The family went to a morning service at the Hershey Lutheran Church. He hadn’t been to church much lately, pushing God away, denying his faith to make room for Gwen.
Sunday afternoon the gorgeous fall weather continued, and Rob went for a walk by himself at Schenk Park to sort out his thoughts. For the first time in a great while, he felt that he could think clearly. It was as if he had been lifted up out of a dense fog and could actually see his surroundings—see where he had been and what lay ahead around the bend.
He could see the enormity of his mistake and was left to wonder about his motivations. Several questions taunted him. How could Gwen possibly wield this power over him? What was this strange emotion dancing about his brain that commandeered his rational mind and ordered him about? Couldn’t he rise above this with the help of God? He paused in his walk to listen as a breeze came up. The rustling of the trees seemed to be whispering something to him, but he couldn’t quite make it out.
The logical part of his brain screamed that all the red flags were up—it was a frickin’ flag frenzy. Everything about it was wrong. It would be an end to all that was peaceful in his life. Again, what hold could she possibly have on the rational man? And so before he had completed his walk, he vowed to tell her that they must never see each other again.
Rob took off his white coat and hung it on the hook behind the door. He glanced at his watch—4:30 p.m. Less than an hour to go. Just one more nasty task remained: to actually tell Gwen. He slowly realized that this might be harder than he had thought. He certainly didn’t want to hurt her. Things weren’t quite as clear as they had been this weekend; the fog seemed to be reforming. Was that her scent he imagined floating in on the mist? He had the beginnings of a migraine and his gut was doing its familiar knot-tying tricks. He took several deep, cleansing breaths but soon realized the futility of this. His emotions were whipsawing about so violently that they were well beyond the scope of yoga’s healing powers. He threw in a last-ditch prayer.
CHAPTER THIRTEEN
TUESDAY, NOVEMBER 2, 5:30 P.M.
Luke opened his locker door and sat down on the bench. He was tired from the long day he’d put in as late guy. He still had time to make it home to take a walk with Kim if he didn’t dawdle. The thought of Kim—beautiful, pregnant Kim—waiting at home for him helped him forget his weariness. He checked his watch—probably no time to vote, though.
Although the sun was setting earlier each day and the temperature was creeping down into the fifties, Luke and Kim still both loved to take their evening walk together. They would traipse around the quiet neighborhood, hand in hand, and bounce their dreams off one another. Lately, of course, the conversations centered around the arrival of their baby. What would she be like? Were they really ready? How much would it change their lives? And even though Colby tugged on the leash like a dog possessed, Luke had to admit that he actually enjoyed taking the spunky one along.
The overhead intercom crackled to life, spoiling his pleasant reverie: “Case One, OR Number 7. Case One, Room 7.”
Luke jumped up, grabbed his cap, and put it back on. He barely stopped to consider that he had been dismissed and was free to go. Or that he wouldn’t get to take that walk with his pretty wife. He was under no obligation to return to the OR. However, someone was in trouble—probably that poor, terrified lady he had just started the IV on—and maybe he could make a difference. This was, after all, why he had gone into medicine, his overriding need to help people. His dad would never have understood this.
Leaving his clothes draped over the bench, Luke sprinted back into the OR complex. He grabbed a mask and tied it on as he ran down the hallway toward OR 7, bursting through the door into a scene of controlled chaos. Dr. Katz was at the head of the OR table, frantically barking orders to several OR nurses, CRNAs, and anesthesia techs. The surgeon, Dr. Howard, who had already started the lap appy operation, looked somehow very peculiar. Luke didn’t get it at first, but then he noticed that Howard’s hands were uncharacteristically idle as he held the laparoscopic instruments limply, unsure of what to do. His brow was also creased and his eyes were laden with worry. Luke recognized the lady from the holding area, the VIP that Katz was taking care of personally.
Katz looked up and appeared startled by Luke’s entrance. “Daulton, I thought I sent you home!”
“I was just leaving and heard the Case One. What’s up?”
Katz paused for the briefest of intervals. “I think she’s got MH.”
“Wow,” Luke murmured to himself. Malignant hyperthermia was very rare but also very deadly. “What’s the temp?”
Katz pointed to the monitor screen and said, “104 and climbing. We’re getting some ice and the techs are mixing the dantrolene.”
He seemed to have a good handle on things, but Luke knew you could always use help in these bad situations. “I’ll get you another IV,” he said, heading to the anesthesia cart.
“Uh, listen, Luke,” Katz said, locking eyes with him. “I appreciate your offer to help, but I’ve got lots of helpers here.” He gestured to all the personnel around him. “I really don’t need you. You’re free to go.” He waved toward the door.
“I’m fine, really, Dr. Katz,” Luke mumbled as he grabbed a tourniquet and IV supplies from the cart. He knew people in these situations always appreciated help even if they didn’t want to admit it. Anesthesia practitioners were no different than most doctors in this respect—they suffered from a touch of machismo, preferring not to show any sign of weakness.
Besides, here was the perfect opportunity to demonstrate to Katz his dedication to the job, and his knowledge. Luke considered himself something of an expert on malignant hyperthermia as he had just given a Grand Rounds conference on it last year at Penn. His knowledge had to be more current than Katz’s.
“Where’s that ice!?” Katz shouted. “Temp’s 104.5. I need it now!”
Luke applied the tourniquet to Mimi’s pudgy arm and hoped some veins would appear. He found one in her antecubital space and worked on driving a 14-gauge, large-bore needle home. Success! There, that should impress the boss.
“Dantrolene’s ready, Dr. Katz,” said one of the CRNAs.
“Good,” Katz said more evenly. “Bolus it now, the
n start the drip.”
Luke hooked up his IV, turned it on, and taped it into place. It ran like a spigot, and Luke mentally patted himself on the back. He threw his spent needle into the sharps container. “Here’s a fourteen for you,” he said.
“Thanks, Daulton,” Katz said.
An OR nurse came in with two buckets of ice and they packed Mimi’s head and body in ice. Luke always hated this part—it was so dehumanizing. He felt like they were packing a mackerel in the hold of a deep-sea fishing boat.
“Anything I can do, Jason?” the surgeon inquired.
“Just get those trocars out of her and close as fast as you can,” Katz said. “I had to turn all her anesthesia off. The gas acts to trigger MH.”
“Sure,” Howard replied, then put forth tentatively, “How’s it going?”
“Not so well,” Katz said. Just then, Nikolai came in and handed a lab report to Katz. “Oh, shit!” Katz said. “Blood gas is pretty bad. PH 7.09, CO2 is 85.”
“Need anything else?” Nikolai asked. Katz shook his head.
The surgeon went to work closing the belly incisions with gusto, as if he thought it might help reverse the MH.
“Run that dantrolene quickly!” Katz barked.
Luke knew these blood gas values were bad—real bad. The body goes to great lengths to keep the blood pH within very tight parameters; 7.35 to 7.45 was the normal range. Mimi’s pH of 7.09 represented overwhelming acidosis caused by hyper-metabolic muscle tissue. This was how MH killed. It caused an uncoupling of the calcium channels, leading to runaway metabolism, which in turn caused the temperature to skyrocket. The brain and heart cannot tolerate acidosis or the high fever for very long.
Dantrolene, a form of muscle relaxant, was a miracle drug that somehow restored order to the calcium metabolism and cooled things off, literally. The only problem was, it had to be given early enough in the crisis, when the process was still reversible. Also, it came as a powder that was very hard to dissolve and required several people to mix up an intravenous solution. Luke wasn’t about to abandon one of his new colleagues in the midst of an MH crisis.
He studied the EKG tracing. He didn’t see any abnormal beats, but she was taching up a storm at 130–140 bpm. That also wasn’t good. He searched his mind for something they had missed. “Did you give bicarb?” Luke asked.
“I already gave her two amps,” Katz said. Again, Katz was right on the money with his treatment. There wasn’t anything else to do but hope the dantrolene worked its magic before the patient cooked. Katz was holding up well. This couldn’t be easy on him.
Luke heard the irregularity in the audible pulse ox signal before he saw it on the EKG monitor. Premature ventricular contractions, the first sign of cardiac irritability. He glanced over and saw the ugly PVCs on the monitor. Shit—again a very bad sign.
The locker room door squeaked open and in walked Dr. Jason Katz. Luke tried to read his expression but couldn’t.
“Thanks for your help in there, Daulton,” Katz said. “Sorry it didn’t turn out better.”
“Yeah, me too.” Luke didn’t know what else to say—he just sat there staring at his open locker. He was mentally and physically drained. They had worked on Mimi Hinkle for ninety minutes before giving up. Luke was in a state of shock. He still believed they should’ve been able to turn this one around—Katz had caught the fever early enough. Usually it was the delay in diagnosis that cost people’s lives.
Luke had no desire to carry on a conversation with Katz at this point. He was still wary of him after getting reamed out. Three months on the job and Luke had already been involved with an obstetrical calamity and now had participated in his first intraoperative death. What would Katz say to him now? Would this turn into another lecture on what he should have done? And how maybe he’s just not partnership material? Luke stripped off his scrubs and threw them on the floor with disgust, then changed into his street clothes.
“I’ll take care of talking to Mr. Hinkle,” Katz said, breaking the silence. “Go home, for God’s sake.” Katz opened his locker door and tossed something in. “Remember, Luke, medicine is not an exact science. There’s only so much you can do—so much you can control. The rest is in the Lord’s hands.” Katz approached Luke and put his hand on his shoulder. Luke resisted the urge to cringe. “Don’t try to play God, son,” Katz continued. “You do your best, but ultimately the outcome isn’t up to you.”
Luke dropped his gaze. “I guess you’re right,” he lied weakly. Dad would’ve disagreed, too.
“Are you a praying man?”
“No sir, not really,” Luke answered.
Katz seemed vaguely surprised and hesitated for a moment. “Have you heard the words of James from the New Testament: ‘Even the demons believe’?”
“No,” Luke replied, continuing to stare at the floor.
“Perhaps you should consider that verse—belief can be very powerful. Well, pray with me now, anyway, for the soul of Mrs. Hinkle.” Katz bowed his head. “Please Lord, we pray for the soul of Mrs. Hinkle. Watch over her and keep her safe on her journey. May she awaken in a better place, in your arms; in Jesus’s name we pray. Amen.”
“Amen,” Luke said, feeling his throat tighten. He was genuinely touched—and a bit surprised—by the older man’s compassion. He certainly sounded sincere. He hadn’t seen this side of Jason Katz before. Perhaps Luke had judged him too quickly, earlier. Perhaps he had just been doing his job as chief of the department.
But Luke couldn’t shake the feeling that he, himself, had failed on some level. He didn’t want to be a part of any more deaths.
CHAPTER FOURTEEN
TUESDAY, NOVEMBER 2, 6:00 P.M.
Rob locked the door to his office and turned to walk down the hallway. Gwen was suddenly right beside him, wrapping her arms around him.
“Hey, what are you doing?” he asked in mock alarm.
“Finally, you’re done.” She squeezed him tightly and gave him a quick kiss on the cheek.
Rob could feel his face heating. He looked up and down the hallway to see if anyone was watching—it was empty.
“Sorry,” she said. “I missed you.”
“I missed you, too.”
She took a step back. “How much time do you have?”
“Not much. I promised I’d be home by eight.”
“Darn.” He could see real disappointment in her face and was touched.
They started walking down the hall. “Friday night was fun,” she said with a fresh smile. “Thanks again for the moonlit car ride.”
“Sure.”
“And the parking part was nice, too.”
“Right.”
“So, how was your weekend?”
“Not bad.”
“Did you make it to Jessica’s play?”
“Yeah. She was great.”
Gwen stopped walking. “Are you okay?”
“Fine.”
She studied him. “What else did you do?”
“Well, we had a big family dinner after the play.”
“Oh.”
“Cindy makes this chili; it’s really good.”
Gwen didn’t say anything.
“And I took a nice long walk Sunday afternoon to try to make some sense out of this pathetic mess I call my life.” He held the door for her, and they exited the building and walked slowly across the parking lot toward Rob’s Porsche. The lot was mostly empty and dark, except for some sparse overhead lighting. A buzzing sound came from one of the lights.
“Did you figure it out?” she asked.
He chuckled uneasily. “I’m not sure.”
She took his hand in hers and squeezed it gently. “What’s the matter, Rob?”
“Nothing.”
“No, really. I can tell.”
She fixed him with those pretty eyes, and he quickly looked away. He stared at a bright patch of horizon, where the sun had set earlier. The Appalachian ridgeline was beautifully defined, lit up by the delicate hues of twilight.
/> “Look, Gwen. I didn’t really want to get into it here. I’m not sure this is the best place.” Rob shot a glance around the empty lot again.
“I don’t like the sound of that.” She let go of his hand and swept the hair out of her face. “Do you want to take a ride?”
“It’s just—there’s some stuff I’ve got to tell you.” Rob still had trouble meeting her gaze. He saw her nod out of the corner of his eye. “I’ve been thinking a lot about my kids lately. This weekend was rough. Saturday was special—everyone was so happy together.”
She didn’t say anything.
“Then Sunday we all went to church. I haven’t been in a while.”
“You’ve said.”
“You should have seen it, though. The sun was shining in the window on me like a spotlight. And you won’t believe it, but the title of the sermon was Jesus Allows U-turns. I felt like the minister was talking right to me.”
Her eyes began to glisten in the dim light. Still not a word.
“I’m not sure I can do this to them. You and me, I mean.” Rob swallowed, trying to dislodge the lump growing in this throat. “It’s just not right.”
She turned and looked off into the distance. They didn’t say anything for a long time, both just standing there, staring past each other.
Finally he said in barely more than a whisper, “We probably shouldn’t see each other anymore.” The lump in his throat was now painful.
No response.
Rob heard the hospital door open, but didn’t look over. He watched the tears stream down her sad face.
She turned and began to walk away.
“Aren’t you going to scream at me or hit me?” Rob asked after her. “Would you just say something?”
She didn’t stop, but slowed and gave him one last look over her shoulder. She mumbled what sounded like, “Don’t worry. I get it.”
He stared after her, listening to her boots clop loudly on the pavement. More than anything in his life, he wanted to run after her and hug her and comfort her, kiss her, and tell her he didn’t mean any of it; it was all a big misunderstanding. They would work it out. Instead, he held his ground. With a trembling hand, he grabbed the handle of the car door and clutched it tightly, as if it were an anchor in a storm.
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