The Doctor's Secret

by Heidi Cullinan

  Hong-Wei didn’t look up from his study of Zhang’s monitors. “I didn’t feel they were a good fit for me.”

  “Yes, but somehow you thought our moth-eaten outfit was? I am finding you some surgical coverage, and you and I are getting shitfaced once this is over so I can ask you ten million questions, wise guy.”

  “Let’s focus on the patient first.” Hong-Wei’s lips went completely flat, and he grimaced. “I need those meds. I can’t drain the infection until he’s stabilized, but he’s going to keep crashing until—”

  On cue, the monitors went off again, but this time no one intervened, only let Hong-Wei do his job.

  “The infection is chewing up his heart, not to mention his kidneys and liver, and I damn well know St. Ann’s doesn’t have the equipment he needs if this keeps up.” Hong-Wei’s gaze darted to Simon’s. “Get a status on the medication from Eau Claire. Also someone call in the hospital pharmacist for me. I need help thinking outside this box.”

  Owen glanced up. “Who’s on call?”

  Susan looked up from the computer where she was typing notes. “I think it’s Tony Hansen.”

  Owen curled his lip. “Absolutely not. Call Dan Newcomb and tell him I’m calling in my you-owe-me.”

  As Susan went to make the call, Owen returned his focus to Hong-Wei. “Trust me when I tell you if you’re playing around with medication while you wait for the drugs you want, you want Dan, not Tony. He used to work at U-W at Madison, so he has more of the experience you’re after. He lives close too, and he’ll come without asking questions.”

  “Thanks.”

  Simon was pretty sure Owen was bantering to keep Hong-Wei level at this point, because he seemed to be reaching for conversation. “You said the medicine you wanted was on the ambulance from Eau Claire. What are the other couriers for?”

  “Insurance.” Hong-Wei wiped at his brow with his sleeve. “Has anyone checked on Mrs. Zhang? Does she still have an English-speaking interpreter with her?”

  Rita popped off the wall. “I’ll go check.”

  Mrs. Zhang was alone in the waiting room, rocking and weeping silently with her eyes closed. When Hong-Wei heard this, he had Rita hold up her smartphone so he could record a message in Mandarin. It sounded different than usual, more formal and rhythmic. When he finished, he told her to go and play it for the patient’s wife. “Bring her hot tea. Green if you have it, or herbal, but bring her something. Don’t ask. Just bring it. Someone sit with her. Hold her hand. You don’t need to speak her language to comfort her. You simply have to be human. But play that recording for her as much as she wants to hear it.”

  Simon knew he should be quiet, but when Owen was busy and it was only the two of them monitoring the patient, he leaned close and asked, “What did you record?”

  “Something to make her feel a little less alone.” He kept his focus on Zhang’s monitor, a tic forming in his cheek. “She probably sent the waitress back to give directions to the others to finish closing the restaurant, and because she didn’t want the girl to see her worried. She doesn’t have need of a translator right now. Either I’m going to come out at some point and tell her that her husband is alive, or I’m going to give her the news she’s been dreading. Everything else is noise.”

  “They didn’t close the restaurant?”

  “The place could burn and they’d try to cook on the flames. You don’t understand what those jobs mean to the people who work there.”

  No, Simon didn’t. Which was some kind of irony, wasn’t it, given the argument he’d had with Hong-Wei earlier?

  Are you scared for your job, or your heart?

  Or was it so noble? Was he simply only thinking of himself?

  Jared stuck his head past the curtain into the room. “Ironwood courier almost here. About five minutes.”

  Hong-Wei nodded. “ETA on the others? Also where’s the pharmacist?”

  “Dan’s in the parking lot. Duluth is an hour out. They’re calling ahead to stop the pilot car, but the one-lane road is crap and they can’t drive like bats out of hell.”

  “I don’t need them as much anyway. What about Eau Claire?”

  “You don’t want to know. I called Andreas and Beckert and asked them to pull some strings. Maybe a chopper ride.”

  Owen shook his head. “They’ll never approve the expense.”

  “He’s going to die without the drug.” Hong-Wei grimaced, staring at the monitor readouts, daring them to dip. “Of course, he might die with it.”

  Jared inclined his head. “What is it, if I might ask?”

  “Brand-new high-powered antibiotic. We were lucky anyone had it.” He rested his elbows on the rail of the bed, looking weary. “Dammit, I could do this if I had a cardiac unit. I’d have sent him to a better facility so he’d have had the option if I’d thought he’d survive a two-hour ambulance ride. But if I’d sent him to Duluth, they wouldn’t have had the drug, and they wouldn’t have known to call for it. They might not have called for it in Eau Claire. It’s not something most people think of. It might as well be on the moon, though, if I can’t get it in him before his organs fail. I’ve got to come up with some kind of stopgap in the meantime. I can’t get an accurate account of what we have, though.”

  The door to the ER waiting room burst open and Dan Newcomb came through, face flushed, glasses askew, salt-and-pepper hair slightly mussed, as if someone had gotten him out of bed and he hadn’t had a chance to put himself entirely to rights. He had on a pair of beige khakis and a plaid shirt, his usual work uniform, and he was sliding into his lab coat as he walked in. “Sorry it took me so long. How can I help?”

  Hong-Wei gave him a quick rundown of the situation, stopping in the middle to adjust the flow of norepinephrine. “I can’t stabilize him, and at the moment I can’t even keep his heart going. I wanted to run through what you have in the pharmacy to get a better idea of my options until my drug of choice gets here, but I don’t dare turn my attention away from him too long.”

  “Sure, sure.” Dan pushed his glasses higher and settled on a stool in front of a monitor. “Let’s start problem-solving.”

  It was something to listen to the two of them shoot back and forth, Hong-Wei seizing on drugs and theorizing doses and combinations, Dan nodding or shaking his head, adding commentary such as “I don’t see a conflict if you keep the dose low,” or sometimes “Considering the other drugs you’ve already administered, you’re at a high risk for a bad outcome if you go that route,” or “Sure, but it’ll rule out the one you’re waiting for.” Simon always marveled at this interplay between doctor and pharmacist: one was a master strategist, the other a walking encyclopedia. Combine the two, and you had an incredible duo.

  They decided to use the Ironwood drug in combination with another and a slight uptick in the flow of saline, and additional vasopressors, and as soon as the courier arrived, Dan had it compounded and ready for Hong-Wei to administer. Everyone held their breath as the drugs went in, but Zhang didn’t crash, and his blood pressure and heart rate stabilized slightly. Not enough to get him into surgery, but enough to buy them some time.

  Then Beckert and Andreas came through the doors, flanked by John Jean Andreas and two other members of the hospital board.

  They lined up at the back of the room, near the ER doctor and other physicians who had been present at the onset of the crisis and hadn’t left. The ER was practically packed to the gills now. Beckert came forward awkwardly. Erin Andreas stood beside his father, unusually silent.

  “So.” Beckert’s smile was strained, and he looked as if wanted to be anywhere but where he was. “It sounds as if we’ve had a bit of excitement here tonight.”

  Owen faced them down before Hong-Wei could. “An emergency, more to the point. Is there something you needed, Beckert? Or did the old guard tattle, and you came here to check on us?”

  John Jean fixed Owen with a quelling gaze. “That’s quite a tone to take with your employer.”

  “There’s been
more than enough tone tossed around here this evening, so yes, I’m not in the mood. I can’t believe you’re lining up like a firing squad in front of a goddamn patient on the table.”

  “A patient who is unlikely to pay,” one of the board members grumbled.

  A collection of soft gasps filled the room. Erin Andreas shut his eyes on a painful wince. Hong-Wei’s hands clenched around the rail.

  Shifting his body to block the line of sight of the others, Simon closed his hand over Hong-Wei’s.

  “Oh, Mark Larsen.” Owen’s voice dripped with venom. “A roomful of witnesses just heard you say that. How do you get to be a board member and not understand it’s illegal to refuse medical treatment to a patient, regardless of anything whatsoever? Wait, I know. You’re our board member.”

  “Don’t bother calling ICE.” Hong-Wei’s jaw was tight, but he linked his thumb with Simon’s as he continued to face away from the board members. “Zhang and his wife have green cards. So do all their employees.” His tone became incredibly bitter as he added, “I’m a citizen, since we’re clearing the air.”

  The board member who’d spoken began to sputter. “I wasn’t implying—”

  “Stop talking, Mark.” John Jean’s voice was chilling. “You’ve put the entire hospital in legal jeopardy. I expect your resignation from the board in the morning. You may leave.”

  Larsen shuffled out, and as the room became a susurrus of whispers, John Jean spoke again. “Dr. Wu, you have my apologies if you felt anyone was questioning your citizenship or your right to treat your patient. However, you must allow this has all been an irregular evening, and now we’re being asked to bring a costly and novel drug to the hospital in the most expensive way possible. It seemed most expedient for you to explain to us in person what was going on.”

  Hong-Wei let go of Simon’s hand and rubbed his temple. Glancing around, he saw Jared and waved him over. “Watch the monitors for me. I’ll give you a set of ranges, and if they move beyond those points, I want to know immediately. If he crashes, I’ll handle the paddles, but I want you to prep them.”

  Jared saluted. “I can do that.”

  Hong-Wei faced the CEO and directors, and the oddly quiet Erin. “You saw my CV when I applied, and you know I had more experience than simply a general surgeon. I had a suspicion only a few of you, if any of you, fully understood what you were hiring. This is it. This is my experience. If you had a cardiac unit and a bit more equipment, whenever a critical case came through, I could keep it from being sent out. Strange critical cases are what I was trained for. I chose not to pursue that career path for my own reasons, and I haven’t regretted working at St. Ann’s, until tonight. What you need to know as a board is I’m saving this man’s life. It would be an easy thing to do if I had a little more equipment and had worked longer with my staff.” He gestured to Simon. “Having Simon Lane on my team is a significant asset. Having doctors such as Gagnon and Kumpel and PharmDs like Dr. Newcomb make all the difference as well. It’s trickier to work under these conditions, but I can manage. The fact of the matter is, this patient would have died in the ambulance had I sent him on to another hospital. If I get the drug I’m seeking, he stands a good chance of living, once I can get him into surgery. If you have the means to get me the drug faster, it would make his odds better. If he crashes too many more times, there won’t be any way to save him.”

  John Jean appeared thoughtful. “Are you saying you can do this for other patients in critical situations at St. Ann’s?”

  “Under specific conditions, yes. The lack of a cardiac unit is severely limiting. Having a second surgeon would also change the game a great deal.”

  “We’re starting to get close to numbers you won’t like, Jack,” Jared called out.

  Hong-Wei talked over his shoulder as he went back to his patient. “Right now everything you’re discussing is theoretical and for another day. I need that medicine. Are you getting it for me, or not?”

  Zhang destabilized a few seconds later, and Dan helped Hong-Wei invent another band-aid drug combination. By the time they’d finished, Erin Andreas came to the foot of the bed. “I’m happy to report a helicopter will have the drug to you within fifteen minutes.”

  The entire room sighed in relief.

  Simon felt Hong-Wei’s hand on his elbow. He glanced down, then up—Hong-Wei was looking right at him. Weary. Scared. Grateful.

  Simon leaned into him as surreptitiously as he could. I’m sorry, he telegraphed with his gaze.

  Hong-Wei squeezed his elbow harder, then turned back to his patient.

  Everything happened quickly once the drug arrived. Simon helped administer the IV, and Hong-Wei watched the readouts as the medicine dripped into Mr. Zhang’s bloodstream. It worked exactly as Hong-Wei had hoped it would, and quicker than Simon had thought possible—twenty minutes later, Zhang’s vitals were stable, and within the hour, they were prepping for surgery.

  Mrs. Zhang had to be brought in to give permission, Hong-Wei translating the form for her and showing her where to sign. She nodded tearfully as she signed, kissing her husband on the forehead and putting her hands together, bowing over him as he left. Hong-Wei spoke over his shoulder to her as they disappeared, and the last thing Simon saw was Mrs. Zhang alone in the ER, weeping silently.

  After that it was simply another night in emergency surgery. Simon had assisted in draining infections before, though never ones with quite this much on the line. Hong-Wei had Rita scrub in as well, and she was Simon’s second assistant, present in case of complications during surgery. Hong-Wei and Owen kept discussing scenarios, Owen pointing out they could still airlift him if need be, Hong-Wei shaking his head and saying it was this or nothing. But there weren’t any complications, the surgery was fine, and soon Zhang was in recovery, waiting to come out of the anesthesia.

  His fever was still high, meaning he was also nauseous and delirious. Normally surgeons weren’t at patient bedsides in recovery, but Hong-Wei didn’t leave, staying beside the tech as Simon and Rita finished postsurgery cleanup, conversing quietly to the patient in his native tongue. The surgeon’s face was gentle but full of exhaustion.

  Simon clutched the blanket he’d brought for Zhang, aching for Hong-Wei. He was at the center of all of this, and despite so many people around him, he’d borne the brunt of this alone. It was his decision to treat Zhang, to reveal the truth about his specialty. He’d stood alone in the ER and fought for the right to treat his patient, invented ways to save him while explaining what he was doing to those attempting to assist him.

  How much of his career was like this before he’d come to St. Ann’s? Doctors were arrogant everywhere. Owen made this intensivist thing sound like a rather new specialty. That meant Hong-Wei had been the young resident, fighting veteran doctors for the right to do his job. Every day. No wonder he had run away.

  Except it wasn’t St. Ann’s that brought him peace, he’d said.

  Feel this, Simon. I’m not a fantasy. I’m standing right here in front of you. Begging you.

  Simon clapped a hand over his mouth.

  What have I done? Why in the world did I turn him away?

  Because I’m scared. Because I’m terrified to do anything that might be a risk, and because I’ve conditioned myself so well to doing nothing but what I’m supposed to do, even if I know it will never make me happy.

  He stared at the man in front of him, finally understanding happiness—real happiness—had been offered to him and he had refused it.

  Please, Hong-Wei, let me not be too late.

  He brought the blanket to Zhang and spread it over him with trembling hands as Hong-Wei continued to attempt to soothe him in Mandarin. Hong-Wei stayed with them as they moved Zhang to the ICU, though on the way he sent a tech to collect Mrs. Zhang, and she arrived in the ICU room as they did, breaking into a sob as she rushed to her husband’s side.

  Hong-Wei spoke to her for some time, and a little to Mr. Zhang, though the patient was still slightly dazed.
When Hong-Wei finished, he called in the ICU nursing staff and addressed them.

  “I’ve explained to the Zhangs what will happen overnight, telling them to trust the staff and go along with what you ask as best as they can. They know some English, and Google Translate is going to help you out to some degree, though it’s also going to be inaccurate.”

  One of the nurses raised her hand, wide-eyed and panicked. “But what language do they speak?” When Hong-Wei seemed briefly taken aback, she added, “I mean, you’re from Taiwan, right? But you can speak to them? How are we going to talk to people when I don’t know what language to use?”

  “I’m speaking Mandarin. But look up Chinese on Google Translate because that’s what they file it under. Both terms are correct.” He put a hand on her shoulder. “It’s all right, Bethany. Breathe. You can do this. You only need words like ‘toilet’ and ‘water’ and ‘blood pressure’ and ‘breakfast.’ If you don’t know how to say it, show Mrs. Zhang the word and she’ll figure it out. You’ll probably end up teaching each other things. It’ll be fine.”

  Once Hong-Wei got the nurses settled, he said one last goodbye to the Zhangs, who thanked him profusely—Mr. Zhang in a bit of a daze, Mrs. Zhang with tears—and then it was time to leave.

  It was almost four in the morning at this point. If they stayed much longer, they’d greet the first nursing shift. Simon could have left after the surgery, and there was no need for him to have gone with Hong-Wei to the ICU, but the truth was, he wasn’t supposed to be in the hospital at all, so he felt like the protocol was off anyway. He wasn’t sure what to do with himself now. He wanted to talk to Hong-Wei, but he wasn’t sure how to start.

  The easiest route would be to give him a ride, to have Owen drop the two of them off, and it had been his original plan, but first he had to be able to get close enough to the man to offer. The second they left Zhang’s room, Hong-Wei was beset by people—nurses, other doctors, even Owen and Jared. The board of directors hadn’t left, and neither had Erin Andreas or Beckert. Everyone kept coming up to Hong-Wei, asking him questions about the surgery, about being an intensivist. They drew him down the hall, away from Simon and into a world he couldn’t access, the elite world of doctors and administration.