by Sanjay Gupta
“Sorry,” Ty said. “My mind was somewhere else.” He forced a smile.
“I guess.”
Ty almost hadn’t recognized her in civilian clothes instead of the scrubs and faux-snakeskin clogs she wore in the OR.
“Hey, Dr. Wilson, this is my grandmother.”
Wilson had assumed the woman in the wheelchair was a patient and hadn’t looked closely. Now he noted the same elegant cheekbones as Monique Tran. The old woman was tiny, practically disappearing in the wheelchair. A lot of his patients barely squeezed into that sized chair.
“Nice to meet you,” Ty said. The older woman bowed her head slightly.
“Doesn’t speak much English. She’s here to get evaluated for a new hip. Didn’t want to come but she couldn’t sleep it hurt so badly. She’s old school. Thinks pain is weakness. Have you seen that T-shirt? PAIN IS THE BODY’S WAY OF LETTING WEAKNESS OUT? That’s her.”
“I guess I haven’t,” Ty replied. Besides the clothes, there was something different about Nurse Tran. And it wasn’t just the mile-a-minute chatter. In the OR, she was practically mute.
“Well, Dr. Wilson, time to get her inside. Can’t wait to hear what she has to say when we get a little Versed on board. Maybe get a little wisdom from the old country.” She laughed.
Ty leaned over and affectionately shook hands with the older woman in the wheelchair. “Who is doing her hip?” he asked.
“We were thinking about Dr. David Martin, I hear he is very good?” Monique said cautiously.
“Uh, sure. Look, I don’t normally do this, but I would recommend Dr. Tom Spinelli. I would have him do mine, if I ever needed one,” Ty offered.
Monique thanked Ty and winked at him as she pushed past. The old woman nodded again as they passed. Monique had been thinking a lot about family since she’d decided to keep her baby. Now all she had to do was convince the father it was a good idea and convince her family that getting knocked up by a white boy, one from the South, no less, was all for the best. And, heck—his Vietnamese was getting better. Surely that would impress her parents.
Monique didn’t mention it to Ty but she’d been named after the old woman she was wheeling through the hospital—sort of. Her grandmother’s real name was Binh, which meant “peace,” but the sisters at Ecole Saint-Paul in Saigon had given her the French name Monique. Through primary and secondary school Tran Binh spent much of her time as Monique, and she had grown to love her alter ego. The name reminded her of the ease of her childhood before the war had crept into their life like mold.
Monique’s grandmother had left Vietnam at thirty-five, pregnant with her fourth child—Monique’s aunt Anh—and the family was suddenly destitute after growing up amid privilege on a leafy street near Tan Son Nhut air base. Her father had been a well-connected businessman, and her husband, Tran Van Vuong, worked for him.
Binh almost never spoke of her old life. When Catholic Social Services sponsored the Trans, they had already endured six squalid and dangerous months in a tent city in Thailand. Days after arriving in the United States, she had gone to work at a box factory to help the family make ends meet. She’d left her children with an older Vietnamese woman who lived nearby or with Monique’s mother, who was just twelve years old at the time.
Monique’s mother had eventually married a fellow refugee, and they’d always stuck close to their own community. Monique sighed and pushed her grandmother into the pre-op area. She thought about telling her about the baby after the IV drip started. Her grandmother was the one person who would probably understand.
CHAPTER 10
S
ydney Saxena woke with a start. A cold rain was lashing the windows of her town house, but it wasn’t the gusting wind or sheets of rain across the windows that jolted her upright, fully conscious, at four in the morning. It was a patient, Joanna Whitman, a large, fifty-two-year-old African American woman who worked for the city of Ann Arbor. The woman was not even Sydney’s patient. Sydney had heard her history on grand rounds, and the story irritated her like an itch. She kept scratching but found no relief.
Sydney did not like mysteries. She liked to know. She needed to know on an almost pathological level, and this patient’s story was like a cipher no one at Chelsea had decoded. Of course, on some level, Sydney also wanted to solve this mystery because she wanted to be the doctor to crack the case. Sydney knew nothing about Joanna Whitman. She didn’t know if she was a mother or grandmother. She didn’t even know what she looked like. For Sydney, this was a clinical puzzle, devoid of any emotion.
Joanna Whitman had arrived at the hospital three months earlier with a runny nose, a headache, and a persistent cough. She had returned days earlier from Aruba, where she had traveled with her husband, and wondered if the circulating air in the plane had blown someone’s flu bug her way. The junior resident who did the H&P suspected a viral infection, and told her it would likely resolve on its own. It didn’t, and the woman returned two weeks later with fevers that were worse at night, feeling slightly winded going up stairs, and still suffering from that cough. A different resident saw her this time and prescribed amoxicillin and also Bactrim, along with codeine for the cough. He gave her strict instructions to take the full course of antibiotics, telling her the infection could in fact worsen if she didn’t. “Yes, yes, I know. Antibiotic-resistant bacteria,” she said in between coughs. The doctor had nothing to worry about. Joanna Whitman did not appear to be the noncompliant type, nor did she seem like a hypochondriac. There was something almost regal about the woman. The resident who gave her the course of antibiotics told her to come back if she didn’t feel better.
Joanna Whitman did just that. She returned to Chelsea General a third time a month later and was diagnosed with bronchitis. She left with another handful of scripts. The cough continued.
During a fourth visit, the woman was sent to get a chest X-ray, which turned out to be normal. There was something unusual, however. Her blood oxygen sats were only 84 percent, and she complained of mild chest pain whenever she took a breath. The senior resident who saw her this time decided she had bronchitis with an asthma component. She was given more medicine and an inhaler. She was collecting diagnoses and medicines, but she was not getting better. She was getting worse.
Joanna Whitman then went away for couple of weeks; she had returned only the day before. It was her fifth visit in three months. This time, the large woman complained of shortness of breath and was admitted overnight. Her husband, a dark-skinned man in a shirt and tie, sat at her bedside holding her hand, an expression of deep worry on his face. The worry was well founded. The doctors who had seen her, including the freshly minted residents, the senior residents, and the attending physicians, were now reduced to making educated guesses at what might be wrong with the woman, or to giving her medicines and tests to rule out different possibilities. Her chart was getting bigger, and that was a sure sign doctors had no idea of the diagnosis. Joanna Whitman was looking sallow, sickly, forlorn. As the rounding doctors walked from Joanna Whitman’s bedside, one resident had quipped out of earshot that they needed to write GOK in her chart: God Only Knows.
Sydney had been thinking about her case off and on in the twenty hours since she had heard the story described by the senior resident on rounds. Sydney was a cardiothoracic surgeon, not a general medicine internist, and yet this case still bothered her. Something wasn’t quite right. The arsenal of medicines Joanna Whitman had received had done nothing, or at least that’s the way it looked.
This woman did not smoke, but she was heavy, and heavy was never good. Sydney thought it would take at least two of her to make one Joanna Whitman. The obesity did not seem to slow the patient down, though, even if she had complained of foot pain and swelling in the past.
Sydney had wondered if she was exposed to airborne irritants or toxic chemicals in her daily life. Studies had shown that waste dumps and other environmental hazards were located more often in minority and low-income communities. Joanna was a midlevel
bureaucrat in the city’s planning department, though, and lived in a middle-class neighborhood not far from Sydney.
Not many surgeons went on medical rounds, but Sydney found them interesting and went whenever she had time. That meant enduring the ribbing from the medical attendings: “How does an internist stop an elevator door from closing? With his hands.” Internists don’t need their hands. “So how does a surgeon stop an elevator door from closing? With her head.” Ba da boom. She thought too many doctors, once they had made the choice between surgery and internal medicine, never strayed across to the other side. Doctors who became internists stereotyped surgeons as scalpel-happy cowboys. Surgeons saw the other side as ineffectual practitioners who analyzed and diagnosed but couldn’t fix problems. There was some element of truth in both stereotypes, of course, but only some.
Her father taught economics at Furman, a small, liberal arts college in South Carolina, and her mother was a columnist at The Greenville News. When Sydney was in high school, her father had come upon Sydney reading an obscure history of the Algerian crisis and labeled her an autodidact. Sydney blushed, thinking he was referring what she had been up to in her bedroom when the lights were out and she thought her parents and sisters were asleep. She said nothing, but looked up the word as soon as she got a chance and realized her father was right. She really did like learning for the sake of learning.
In college, Sydney was a dual English–Biology major. She especially reveled in the mysteries that remained about the human experience. Why did we behave the way we did, and could it be predicted? How were genes connected to behaviors like compassion and morality?
She was fascinated by the basics of human development: How could the cells in the womb become differentiated and migrate where they needed to go as the fetus developed? She also relished arcane experiments that showed how people responded to the world around them: how those who took a dummy cancer drug in a clinical trial could lose all their hair (the nocebo effect); how a child could regenerate a fingertip but an adult could not; how people became happier in anticipation of a happy event, or died of heart failure after the death of a longtime spouse.
Joanna Whitman presented a mystery, and Sydney felt an intense clinical curiosity. She suspected something was seriously wrong with the woman, but she could not put her finger on it. The doctors who had treated her had never strayed far from the initial diagnosis of bronchitis. Once a doctor read the chart, he was most likely to continue down the same path. It was a group-think mentality that occurred too often in hospitals. That was always dangerous, Sydney knew. They should have expanded the possible list of diagnoses, but what would those other possible diagnoses be? Whitman’s heart rate was elevated but her lungs appeared clear. What was going on?
Now, at four in the morning, Sydney thought she knew. She stood by the window, the heavy rain beating an elaborate rhythm on the glass as she called the paging operator. She reached the junior resident on call at the hospital, a Dr. Tom Ottobrini.
“Dr. Ottobrini, this is Dr. Sydney Saxena. Mrs. Whitman needs a lung scan or a CT angio, and she needs it yesterday,” she said breathlessly.
The junior resident was groggy. “Joanna Whitman? You mean the bronchitis?”
“No. Not ‘the bronchitis.’ Pulmonary embolism. Listen, we’re damn lucky she hasn’t thrown a large embolism already.”
“Dr. Saxena. Aren’t you a surgeon?”
Sydney continued, “Wake up your attending. Do what you need to do, but you need to do it now. We’re lucky this poor lady hasn’t boxed already.”
“I don’t know.” The sleep-deprived resident now sounded suspicious, as though he were the target of some sort of prank. Residents never liked calling the attending—waking up their boss with questions that would show they were less than fully trained doctors able to handle whatever came their way. And they shared a special dread of waking up the senior doctor with a question or problem that was trivial or, worse, insipid.
“Listen, Tom, she’s circling the drain. Who’s your attending, Bobby Mitchell? Call him and blame it on me. We were in med school together at MGH.”
“All right, Dr. Saxena, thanks for your call.” The resident hung up. He sounded as though he was getting rid of a telemarketer.
Sydney was seething now. She skipped a shower, roughly brushed her hair, threw on pants, a blouse, and her white lab coat, and ran out of her town house. She forgot it was raining and didn’t bring an umbrella as she half walked, half ran to the car. The cold drops hit her like a slap.
Twenty minutes later and still wet, she was on the fourth floor of Chelsea General. The place looked like it was in state of hibernation. Most of the patients slept. Nurses were hunkered at their stations doing paperwork while they kept one eye on the monitors. A junior resident was walking the halls updating the prescriptions for the various patients.
Saxena walked up to a nurse.
“Joanna Whitman?”
The nurse checked the chart in front of her.
“Four-twelve.”
“Thanks,” she said. “Would you page Dr. Ottobrini and have him meet me there?”
“Yes—” The nurse squinted to read Sydney’s name tag. “—Dr. Saxena?” She clearly didn’t recognize the name.
Sydney walked down to the room. Joanna Whitman was sleeping, her breathing troubled. Sydney checked the chart. Her heart rate had been steadily rising over the last several hours.
She stepped into the hallway and almost bumped into Ottobrini, a rangy young doctor with puffy eyes, stubble, and an irritated look. Sydney was looking up at Ottobrini, but she took his irritated look and raised him a withering glare. No matter which side of the surgery-medicine divide she was on, Sydney was an attending, and he was a resident.
“Listen, Dr. Saxena, I called my senior resident and he said we shouldn’t bother Dr. Mitchell with this. He said to hold off—”
Before Ottobrini could finish his sentence, a balding doctor with stooped shoulders joined them. Ottobrini was surprised to see him.
“Bill?”
“Tom.” The senior resident turned to Sydney. “And you must be the intrusive Dr. Saxena.” Despite his words, he didn’t look or sound annoyed. A smile played at the edge of his mouth. He turned back to Ottobrini.
“Order a spiral CT for Mrs. Whitman.” The junior resident’s red eyes goggled. “Go on.” Ottobrini went into the room and started writing on Joanna Whitman’s chart.
The senior resident turned back to Sydney.
“Couldn’t get back to sleep after he called.” He held out his hand. “Bill McManus.”
“Sydney Saxena.”
“I pictured you bigger. Maybe with a long crooked nose. A wart on your cheek.”
“Give me a couple more years.” Sydney laughed. With a start, she realized it was her thirty-fifth birthday.
“I hope you’re right about this because up till now we haven’t had a clue.” Sydney felt a surge of admiration for this senior resident. Not many doctors were so willing to set aside their egos, even when the patient’s best interest might be at stake. He looked at Sydney for a second, and then awkwardly put out his hand. She shook it, firmly. “Okay, well, thanks. We will let you know what the test shows,” he said. She nodded confidently, and they separated, walking in opposite directions.
At noon, Sydney received a page to the fourth floor. “McManus,” a voice answered. Her suspicions were correct, he went on to tell her: Joanna Whitman had a pulmonary embolism and was already on an around-the-clock infusion of heparin. She had been throwing small emboli to her lungs, which were impeding her breathing and causing symptoms similar to a lung infection. Bill McManus paused after describing the results of the scan and then out of the blue, asked Sydney out on a date. Even though she was taken aback, she regained her composure quickly. And then, as she always did, she declined. She gave her pat answer and said she was committed. She didn’t tell him that she was committed to the hospital. At least she was still getting asked, even at the “advance
d” age of thirty-five, she thought to herself.
A few days later, McManus ran into Sydney at Joanna Whitman’s bedside. Sydney wanted to finally meet the patient for herself. Whitman’s husband now looked exhausted and relieved, instead of exhausted and worried. An IV bag dripped the blood thinner heparin into the patient’s left arm. Sydney held her right hand.
“Well, look who’s here,” McManus said. Sydney couldn’t help but appreciate the obvious joy he took in seeing her.
“Mrs. Whitman, I’m betting she hasn’t told you this, and I’m embarrassed to admit this myself, but Dr. Saxena was the one who solved your medical mystery.”
Joanna Whitman looked up at Sydney. She squeezed her hand between her own.
“Thank you, honey. I was beginning to think I was going crazy. Making up the symptoms out of the clear blue.”
Sydney smiled.
“You take care, Mrs. Whitman.”
As Sydney turned to go, Whitman’s husband called after her. “Doctor.”
Sydney stopped. He reached out his bony hand and shook hers.
“Thank you. Thank you.”
That afternoon, Sydney did what she’d done every year on her birthday since she’d turned thirty. She drove to the playground not far from her town house. The rain had pushed east but the clouds remained and there was a chill breeze blowing, a harbinger of winter. Still, the hardier young mothers—or maybe those suffering from cabin fever—sat on benches while their bundled preschoolers chased one another, climbed the ladders, went feet-first down the slide, or simply sat in the damp wood chips, lost in their own world. The mothers chatted, always with one eye on their progeny.
“Be careful,” they’d call out. Or, “Look at you!” to a little girl who went down a tornado slide. “Share!” to a boy who wouldn’t give up the wagon he was pulling. “Carter, do not throw sand!” Words of praise, advice, and discipline in the years-long quest to produce happy, successful offspring.
