by Sanjay Gupta
It was after this game that Villanueva’s father decided to express his dissatisfaction about George’s career choice. They were sitting in a booth at the back of a generic hotel restaurant. His mom had a worried look. His dad was harder to read. The smoking had damaged his body’s ability to absorb oxygen, which meant he had a portable oxygen tank anytime he left the house. It also meant his face carried a perpetually pinched expression. George recalled his father’s gray pallor and how thin he looked.
“Son, you are a smart boy. Muy inteligente.” His father paused to catch his breath. “When I was at the plant, I always imagined you’d have a job where you wore a tie to work.” His father paused again. Breathed deeply and began again. “Yes, you are well paid. But what you do is not so different than what I did. Using your brawn, not your brains. I want more for you, Jorge.”
Villanueva’s father had peered at him intently, trying to get his message across with his receding black eyes because speaking was such an effort. Looking back, George still became a little choked up when he realized his father must have been planning a much longer speech but cut it short. His father died the next year and never saw how the Big Cat had remade himself when his playing days were done. He had used his brains after all. At the time, Villanueva was simply a twenty-one-year-old kid who considered himself stronger and badder than anyone out there.
“C’mon, Papi. We won. Time to celebrate.”
Villanueva had hoisted his frosted mug of beer and downed it. His father hadn’t budged. As he pictured his father sitting there, already one foot in the next world, George could see disappointment in his half-dead eyes, and the Big Cat wondered if father-son relationships were ever uncomplicated. Was anyone ever free of the burden of a father’s expectations? Villanueva snorted at the notion that even now, when he was at the height of a career that was all about using his inteligencia, he didn’t wear a tie, and he wondered whether his father would be disappointed. Then he thought of his own son, Nick, and wondered if his life would be marked by both a father and a son who were disappointed in him.
Villanueva took another gulp of beer and returned his gaze to the field where the Lions had just given up a big run. Most Lions fans were disappointed. George saw how the pulling guard had taken out both the defensive end and the pursuing linebacker and smiled. Couldn’t have done it any better himself.
Two hours and three quarters of football later, Villanueva was hoarse from yelling and his enunciation was slurred from eight or nine beers. George had a unique way of watching football. He cheered for the offense no matter which team had possession. And just like in the ER, Gato always picked up things on the field everyone else missed.
“Great block, Witherspoon! Hey, Mitchell, how’s it feel to get knocked on your ass?” Villanueva’s voice was so loud Ty thought there was a fifty-fifty chance the players could actually hear him.
During a TV timeout, when players from both teams were standing around looking like quarterhorses before the next race, George turned to Ty.
“I had a kid once.”
“Once? Don’t you have a son?” Ty was confused.
“A kid. A kid I couldn’t shake. A six-year-old. Hit by a drunk driver.”
Ty shook his head in disgust. He tried to picture the scene. The normally unflappable EMTs racing into the emergency department with panicked looks, hoping they were wrong and the small unmoving body on the gurney was not going to die. Hoping the absence of vitals wouldn’t matter. Nor would the fixed pupils. Nor would every other bit of data they were trained to collect. The hippocampus, the subjective part of their brains where they stored the memories of their own children, held on to the irrational hope that since the boy was so young, and since the doctors at Chelsea were among the best in the world, the boy might have a chance to survive. And the next day or the next week, his case would be the one they asked about, knowing the answer before they asked but needing to know.
“When he came in, he had no pulse,” Villanueva said. “His head was bigger’n mine. His body was torn to shit. Could have pronounced him right there.” Villanueva paused. “We started CPR. Steroids. Epi. You name it. Still, the poor kid never stood a chance. Hadn’t thought about him for years until your case came up. You ask around. Everyone’s got a kid.” Ty felt a surge of bile in his throat.
George turned back toward the game. Ty waited for more, but Villanueva was back to cheering for the offense. The Lions this time.
“Helluva block, Smith. Helluva block.”
“Hey, George,” Ty said above the din, nodding toward the field. “You miss it?”
“Shit, I’m lucky I got out of the game before my knees were shot and I needed a couple of TKAs.” Still watching the players, he added, “You know what Mickey Mantle said when someone asked him if he missed baseball? He said, ‘I miss the guys.’” Villanueva nodded to himself at the truth of this statement.
A beer vendor wended his way up the aisle. Villanueva raised a hand almost the size of a dinner plate.
“Yo, beer man. Two!”
Ty had been thinking a lot about “his kid” lately. He’d been thinking even more about Quinn McDaniel’s mother, Allison, who’d told him her son was her “everything.” The mention alone had seemed to light her up from the inside. Ty felt he owed her something, though he couldn’t say what. Also, he wondered again how she was doing and promised himself he’d find out, knowing full well the hospital’s attorney, colleagues, and common sense all argued against it.
CHAPTER 9
T
ina arrived at Harding Hooten’s office on the top floor of the hospital at the appointed hour. Hooten and the hospital’s attorney were waiting in a pair of chairs in a small sitting area in front of his desk. Not a good sign. Hooten was wearing his white lab coat and a striped bow tie. The attorney wore a generic but expensive suit. Neither one of them was smiling. The last time Tina had been to Hooten’s office was when he hired her to be an attending. There were smiles all around then.
“Tina, sit.” Hooten motioned to the couch. She sat. Hooten adjusted his bow tie and began. “I want to talk about Dr. Robidaux. I’ve been speaking with Todd about the lawsuit brought against the hospital as the result of her work. Of course, we are insured, but paying out a big judgment is never in the best interest of the hospital. I’ve had to call the CEO to let him know about this, and, as you can imagine, that was not a pleasant conversation.”
“Dr. Hooten,” Tina began. “I made the judgment that Dr. Robidaux was ready for the procedure.”
“Tina, we get in trouble when we have residents perform surgeries like this one.”
“We do it every day, Dr. Hooten. Isn’t the old saw, ‘See one, do one, teach one’?”
“You were the attending, you were clearly more qualified.”
“The attending is always more qualified.”
“But in this case—”
“This case is no different than hundreds of others at this hospital every day. If the attendings do all the cases, how are the residents going to learn?”
Hooten sighed. He was annoyed Tina had challenged him. He took a breath and started over. He adopted the voice you might use to talk a potential jumper from the ledge of building.
“Tina, you and I know patients expect the best here. And for the most part we give it to them. It’s a testament to your skills and the skills of the other doctors at this facility. You know what they say, ‘If you get shot or get in a wreck, just hope you’re near Chelsea General.’ That glib commentary carries with it more than a grain of clinical truth. We handle very challenging surgical cases with few complications.”
Hooten paused again and sighed. His hands were clasped in front of him. Tina’s jaw was set, and she sat with her weight perched on the edge of her seat, waiting to hear whether Hooten was going to throw Michelle Robidaux under the bus.
“Now, here’s this young chef who can no longer smell—”
“That side effect is something even the most experienced surgeon enc
ounters now and then,” Tina interrupted. Her voice was more defensive, shriller, than she wanted.
“Damn it, Tina, let me finish.”
The attorney, who had been sitting with his hands folded in his lap as he thumbed his BlackBerry, looked up and spoke for the first time during the meeting. “Michelle Robidaux was not the most experienced surgeon, though, was she?”
Tina scowled at the lawyer and then turned back to Hooten.
“Tina, I’m going to get to the crux of the matter. Todd here has recommended that we terminate our contract with Michelle Robidaux, effective immediately.”
Tina flushed. She felt her stomach release a spurt of acid, and she was momentarily without words. She silently counted to ten to calm herself down. “So, this is how we back our residents. This is a teaching hospital, Dr. Hooten. We teach. Residents learn. We don’t throw them under the bus. You want to discipline someone, discipline me. I assigned her the case.”
“Tina, I know how hard you’ve worked with this resident, but she may not be Chelsea material—”
“This is just wrong and you know it.” Tina could think of nothing else to say. She stared at Hooten, her jaw set.
The attorney spoke up, looking at Hooten as he did. “The hospital is just too exposed on this one.”
Tina ran through the cascade of events that would unfold for Michelle Robidaux. She would lose her job, her wages, her standing in the medical community. She would lose her legal representation and whatever shred of self-respect remained. She would probably return to Louisiana, where her family would no doubt let her know how foolish she’d been to think folks at big-name hospitals would accept their kind. Who knew what would happen after that? She felt her gut clench as she envisioned the next days and months for Michelle Robidaux, the first in her family to go to college.
“I can tell nothing I say is going to matter,” Tina said. Without another word, she got up and walked from the office.
“Tina, don’t turn your back on me,” Hooten called after her. She didn’t look back.
Park enjoyed the spotlight, even when he was presenting at M&M, even if it meant explaining Ruth Hostetler’s post-operative sequelae of unbidden sexual desire. Park had toiled in obscurity for too long, first in Korea and then in the United States, not to savor his moments standing front and center. It was tough being on the bottom rung of the ladder, looking up, when you knew you were the smartest man in the room, and Park had little doubt he was the smartest man in the room most of the time.
He looked around at the doctors seated in front of him. He saw his fellow attending neurosurgeons Tina Ridgeway and Ty Wilson sitting next to each other. Tina Ridgeway was smart. Ty Wilson had magic hands, but he was no intellect. Neither one of them could match Park’s command of data, research, knowledge. Harding Hooten might pose a legitimate challenge, Park thought, but he was nearing retirement and could not match the raw drive Park brought to his job.
“We all know the story of the famous Phineas Gage in 1848,” Park began. “He was construction foreman for a railroad in Vermont, blasting rock, when a thirteen-pound tamping iron shot through his brain. The bar entered left cheek, traversed his frontal lobe, and exited here.” Park pointed to a spot just above his forehead, directly above the bridge of his nose.
“Did he get choppered to Chelsea General?” Villanueva called out. There was a smattering of laughter.
“I gotta make rounds at seven, can we skip ahead to the twenty-first century,” someone else called from the back of the room.
“Sounds like he was stuck between the eight-ball and a hard place,” came a third voice. Sung scowled.
Everything was a joke to Americans, Park thought. Life was serious business, bound by laws of obligation, honor, and family, but Americans thought they were living in one of those comedies they watched on television, with the action punctuated by artificial laughter every ten or fifteen seconds. Perhaps the pleasure centers of their brains had been rewired at a young age. When Park was a child, he would return home from school and either study, practice violin, or help his parents in their small and failing general store.
This was one of the Americans traits that vexed him. There were many others. Americans were also always in a hurry. They ate fast, drove fast, rushed from one thing to the next. They flipped channels, read headlines or abstracts or executive summaries, and then moved on. Shouldn’t you truly understand something before continuing to the next thing? This morning he was offering the assembled doctors a gift, a sculpture of ideas on the nature of brain injury, but they wanted him to rush through it. No one here wanted to savor the breadth of understanding the medical profession had gleaned in an eyeblink of history. Park was flustered. As a result, he spoke faster, with choppier English, and his grammar started falling apart.
“We all know Phineas live, but he is changed man. His personality surly. He swears a lot. His reasoning skills, diminished. His doctor offer him one thousand dollars for a pocketful of pebbles he collect, and Phineas refuse.”
“Dr. Park,” Hooten injected in a quiet voice. “This discourse is best suited for another time. Would you mind if we present the case of Ruth Hostetler?”
Park sighed, irritated that his history lesson wasn’t hitting the mark. He explained the facts of the odd woman in the print dress. He told his colleagues how he had placed a stereotactic frame on the patient, secured with screws that were placed through her skin and into the skull. He’d then made a precisely fourteen-millimeter incision over the right top of her head and used a perforating drill to expose her brain. A thin probe was then snaked directly into her brain, having been measured perfectly the night before. A slight charge was given, and the deep tissue stimulation had eliminated the patient’s tremors but produced a strange side effect, an awakening of carnal desire in this deeply religious woman.
“Was this side effect, this carnal desire you describe, was it directed only at her husband or was it directed at others in the room? You, for example?” Villanueva asked to more guffaws.
“George may want her phone number,” a male voice called from the back of the room.
“Gentlemen,” Hooten said. “We are not in a locker room. We are in a time-honored forum established so that we may learn from our mistakes. So we can become better surgeons and make this a better hospital.”
“Ruth Hostetler is like a modern Phineas Gage,” Park said. “We learn a lot about the brain, but there are things that remain unknown to us at this time.”
“Would you perform this procedure differently next time?” Hooten asked.
“Because etiology of side effect is not known, I say no. I do the same way,” Park said. He thought about the question a little more. “Two choices for us: Do not do deep tissue stimulation. Try medicine to solve the problem. Or, do deep tissue stimulation and accept the fact we do not know everything that may happen. I do the same way.”
“Very well, Dr. Park,” Hooten said. “A cautionary tale,” he added to the room at large.
Joining the doctors in the queue shuffling out of the room, Ty turned to Tina. “Did you see the study that found there are two hundred thirty-seven reasons people have sex?”
“Missed it,” she said, laughing.
“There were the obvious ones: ‘I was drunk.’ ‘For pleasure.’ ‘To reproduce.’ There was also ‘to feel better about myself.’ ‘To be closer to God.’ ‘For revenge.’ ‘For power.’ Need to add number two thirty-eight. Deep brain stimulation.”
“If the word gets out, the procedure could challenge breast augs in popularity,” Tina mused.
“No doubt.”
The two reached the hallway outside Room 311. Tina turned right. Ty turned left.
“You’re not heading this way?”
“Got something to do,” Ty said.
Every time a doctor checks a patient’s records, he or she leaves electronic fingerprints. The hospital software was written to prevent curious doctors checking out the blood alcohol level of the Wolverines wideout a
dmitted to Chelsea General after a car accident or the rap star’s lab results. Administrators take these breaches seriously. Doctors who weren’t directly involved in a patient’s care were warned to stay away from that patient’s electronic record. Chelsea General went so far as to kick a senior resident out of the orthopedics program for his curiosity over whether the rap star was high on marijuana or cocaine. Both, it turned out.
Ty found a computer in one of the hospital’s backwaters, a room in Pediatrics. He didn’t think the hospital would raise an institutional eyebrow if he checked Quinn McDaniel’s records. The boy had been his patient, after all. Wasn’t it laudable to review the records of his most damning case as a neurosurgeon? The software and those who monitored it would have no idea Ty wasn’t interested in when Quinn’s oxygen sats went south or how many pints of blood the boy had received before Ty had pronounced him. Ty wrote down only one bit of information from the boy’s records: Allison McDaniel’s address and phone number.
Even though Ty had officially done nothing wrong, he looked around. It was as though he was checking to see if store security was watching after he stuffed the James Worthy shirt into his pants. Ty had been so angry after his brother died that he’d done quite a bit of shoplifting, almost daring someone to stop him. Once, he took a basketball out of a box at a sporting goods store, inflated it with a pump the store was selling, and wrote his name on it with a black Sharpie he had brought with him. He then dribbled it out of the store. He never got caught. Even then he had quick hands and nerves.
As he left the room, he almost bumped into Monique Tran, who was pushing an older Vietnamese woman in a wheelchair. Monique was the scrub nurse who had been working the night of Quinn McDaniel’s death. She had watched the life drain out of the boy. Ty looked at Monique as though he’d seen a ghost.
“Don’t look so happy to see me, Dr. Wilson,” Monique joked.
