by Sanjay Gupta
“Couldn’t afford test strips.” He looked down at his feet, a little embarrassed. “Been rolling the dice the last couple days, I guess.”
“What about your medicine?” Tina asked as she unlocked a cabinet and pulled out a vial of insulin and a syringe.
“C’mon, Doc. How can I afford that if I can’t even get the strips?”
“Why’d you come in today?”
“My eyes started getting a little blurry.”
Tina handed her patient a glass of water as she gave him an injection. Tina disposed of the spent syringe and turned to him.
“We’ve got insulin. We’ve got test strips. You run out, Mr. Leggett, you come here.”
“All right, Doc, and thank you. So much.”
She smiled at Darryl. Thank you—it wasn’t something she was used to hearing.
At The Free Clinic, Tina came alive. There was hardly any paperwork, no departmental politics, no bureaucracy; there were no lawyers, little protocol. It was simply her knowledge and skill as a doctor pitted against an incredible array of medical problems that walked or hobbled or wheeled through the door, most of them festering for too long—because the patient either couldn’t afford to take care of them or couldn’t afford to miss work or couldn’t get a ride or didn’t know where to go. Sometimes, Tina suspected, her patients at The Free Clinic delayed their visit because they had internalized the belief that they and—by extension—their health problems simply didn’t matter in the greater scheme of things.
Patients she saw put off being treated for almost everything. After Mr. Leggett left, a fifty-year-old woman named Patty Steinkuhler arrived with five teeth rotten to the gumline. From Tina’s experience at The Free Clinic, teeth were dead last when it came to health priorities. Tina called an oral surgeon who had agreed to take a couple of cases a month from the clinic.
A Salvadoran infant with a high fever was next. Bring it on, Tina thought. I can do this, and I can make a difference. For some reason, this made her think of home. With Mark, Tina wasn’t sure anything would make a difference anymore. The older girls, too, seemed increasingly remote. They went to Mark with their issues. The sad thing was, Tina was gone so much she wasn’t exactly sure what their issues were. Tina made a mental note to spend some one-on-one time with them. Her thought was interrupted by what she saw through the clinic’s plate-glass window: an old man clutching his chest.
“Come on,” Tina said to DeShawn, who managed the clinic. The two of them ran out the door. Tina was exhilarated.
CHAPTER 20
T
he transplant team arrived in Earl Jasper’s room in the Neuro Intensive Care Unit exactly eleven hours and fifty-nine minutes after he had left Chelsea General’s emergency room on Dr. George Villanueva’s orders.
Jasper, the white supremacist who had killed his grandmother, remained motionless in the large mechanized bed. He was attached to monitors that showed his heartbeat and blood oxygen levels. A hose from Jasper’s mouth led to a large ventilator on the other side of his bed. The machine exhaled with a loud whoosh every few seconds, causing Jasper’s torso to rise. A monitor registered a tone each time the ventilator breathed for Jasper. The goal was fourteen breaths a minute, with a tidal volume of seven hundred. Other than the machine, there was none of the usual activity that surrounded a patient in an ICU.
A police officer dozed on a chair in the corner of the room. Until Jasper was pronounced dead, he was officially wanted for first-degree murder. The officer was not supposed to leave Jasper’s side, but deeming him a low flight risk, he had spent much of his time, when he wasn’t sleeping, at the nurses’ station and the cafeteria. The peach cobbler, he found, was excellent.
Nurses on the ward had greeted Jasper’s arrival early that morning with a mixture of chagrin and disbelief. It was as though someone had keyed their car, or someone’s dog had taken a crap on their lawn. Many of the nurses were African American, and having a neo-Nazi in their midst posed an ethical challenge. As the morning shift arrived, they huddled in the nurses’ station with the overnight crew. They wondered aloud about whether they were somehow condoning his worldviews if they treated him decently, or treated him at all. They also considered the consequences of denying Jasper care. Was that the right thing to do? Would that force him to be transferred to a different hospital? Or would they simply get fired?
As they were hashing out these issues, the hospital’s chief of nursing Nancy Woldridge arrived unannounced, interrupting their nascent plotting. Woldridge was a tall, rail-thin white woman with coiffed white hair. She walked with a pronounced limp from a childhood bicycle accident. The nurses gathered around Woldridge at the semicircular nursing station, arms crossed, lips pursed, expressions sullen. They did not like management coming down to tell them what they had to do, especially when it involved a racist cracker like Earl Jasper.
“I’m not going to require anyone here to care for that man in there,” Woldridge began, her voice carrying just the hint of a Southern accent. The nurses looked at one another, surprised.
“He’s going to be lonely,” one of the nurses quipped. They all laughed, even Woldridge. When the laughing died down, Woldridge continued, looking at each nurse as she spoke.
“You nurses are among the best we have here at Chelsea General. You deal with very complicated patients and you do it very, very well. You’re also professionals with a capital P.” Woldridge paused for a moment.
“I’m not going to force any of you to care for the patient in there,” Woldridge said again. “But I’m hoping I can count on your professionalism. I’m hoping I can count on the pride you take in how well you do the hundreds of little things that make you such outstanding nurses. I am not going to force anyone here to take care of that man, but I’m hoping I can get volunteers. I’m not asking you to like him, or to understand him, or even respect him.” Woldridge paused. “I’m hoping you are willing to care for him.”
Woldridge’s thin face turned from one nurse to another. “But let me see a show of hands on who is willing to not only care for him, but give him the best care you are capable of. The kind of care you’d give to a member of your own family. Anyone who does, I think, will be showing how much better you are than he is.”
Woldridge looked around for a show of hands. The nurses looked at one another. Finally, the head nurse, Nicki Hampton, raised her hand. Then a second nurse, and a third. Finally all the nurses raised their hands.
“Thank you. You make me proud,” Woldridge said. She shook each of their hands, thanking them by name, and then she limped down the hall toward the elevator.
As a result of Woldridge’s speech, when chief transplant surgeon Dr. John Magee approached Jasper’s bedside, he found a patient with a head wound that had been immaculately dressed and wrapped. Looking at him, you wouldn’t know Jasper was loathed by everyone in the ward.
Even with the neatly wrapped bandages, though, it was obvious that part of the right side of Jasper’s head was missing. Bandages also covered his missing right eye, and a silastic catheter drained blood-tinged fluid from his brain.
“Is he ready to go?” Magee asked. He was short and stocky, with an annoyed look. He was already dressed in scrubs with a book of transplant protocols under his arm. On his walk over to the ICU, he had called the operating room to make sure his instruments and team were at the ready.
“I think so,” said Nicki Hampton. “Let me just ask our resident, Dr. Robidaux.” The final exam to confirm that he was brain-dead needed to be done. Hampton walked away as Magee did nothing to hide his impatience.
Michelle Robidaux approached the patient the way a zookeeper might approach a hissing cobra. It was obvious she had never done this before. Magee stood with his arms folded, drumming the fingers of his right hand on his left forearm.
“Take your time,” the transplant surgeon said. “You don’t want to startle him with any sudden movements.” Hampton covered a laugh with her hand. Others in the room weren’t as polite.
“Mr.
Jasper. I’m Dr. Robidaux, can you open your eye?” she said as though she were calling to someone behind a closed door. Magee threw his hands up. Other doctors on the team shook their heads.
“Look, can you speed this up. We have six patients around the country waiting for these organs.”
Looking unnerved, Michelle leaned over Jasper and opened his left eyelid. She shined a penlight into the eye from an inch away.
“Left pupil fixed and dilated.” She then lifted the man’s limp arm and pinched the base of his fingernail. Jasper made no attempt to pull his hand away.
“No response to pain stimulus.”
Magee rolled his eyes and snickered. A flustered Michelle approached Jasper and shouted in his ear.
“Mr. Jasper, if you can hear me, hold up two fingers.”
“Oh come on,” Magee drawled to more laughter from the assembled group.
Jasper’s right arm went up, two fingers extended. The laughter died. The police officer in the corner sat bolt-upright.
“Whoa,” Michelle said. She was so startled she had jumped back away from Jasper as though she had raised the dead herself. For a split second—before logic regained control of her consciousness—she wondered if she had invoked some sort of Louisiana voodoo.
Jasper had the scratchy blue ink of a prison tattoo on the fingers of each hand. The left hand spelled love, one letter on each finger: L-O-V-E. The right hand spelled hate: H-A-T-E. Robidaux noticed the blue ink on the two fingers Jasper extended—the index and middle fingers—spelled H-A.
Michelle let her breathing return to normal and then leaned close to Jasper once again. “All right, Mr. Jasper. How about three fingers?”
His arm still aloft, the patient lowered his index finger until only his middle finger was raised. He was flipping the bird at the assembled medical team.
Magee’s face reddened. Without a word, he turned and left the room.
“Next time you want the transplant team, make sure your fucking patient is dead,” he said.
Michelle had recovered from her shock and was now almost giddy.
“We almost removed this man’s heart, his kidneys, his liver, his left cornea—and he is actually still alive,” she said. She paused for a moment. “Who declared him brain-dead in the first place?”
“Well, El Gato sent him up here,” said Hampton, the nurse. “Don’t know what neurologist saw him.”
CHAPTER 21
T
ina Ridgeway was standing in the lobby of Chelsea General answering a resident’s question about surgical versus nonsurgical approaches for Parkinson’s disease when Buck Tierney, the chief of cardiothoracic surgery, strutted through the main entrance with the hospital CEO, Morgan Smith. Tierney always strutted rather than walked, chest out, chin up, like some sort of rooster, but now he was grinning from ear to ear, slapping Smith on the back like they were fraternity brothers at Michigan on the way to the big game.
Tina looked around for some sort of explanation for this ebullience. She didn’t trust Tierney and his outsized ego. If he was showboating with the CEO, something was up. Out of the corner of her eye, Tina saw the chief of medicine, Dr. Nicholas Brenkovski, heading for the elevator.
“Excuse me,” she said to the resident and half walked, half ran to catch up with him. Tina was friends with Brenkovski and his wife. They each had a house near South Beach in Edgartown, on Martha’s Vineyard, and would sometimes have each over for cocktails and boiled lobster. Tina caught him just before he got on the elevator.
“Nick, could I have a word?”
The two doctors stepped out of the stream of traffic heading to and from the elevator.
“Tina, how are you?” Even though he had been in the United States for more than twenty years, Nick retained a trace of his Russian accent.
Nick, I just saw Buck Tierney and Morgan Smith walk in the hospital looking like a couple of lovebirds. You seem to know everything that happens around here. What’s going on?”
“Tina, you haven’t heard? Our friend Buck has convinced Morgan to build a new, forty-million-dollar cardiac care wing. He will run it by the board, but it looks like a done deal. We will be the cardiac hospital of the state, maybe the region.”
“But how did he pull that off?”
By all accounts, Whitfield Bradford Tierney III lived a charmed life. Chelsea General’s chief of cardiothoracic surgery was a square-shouldered, square-jawed former football star known to all as Buck, the nickname he’d received when he bagged a five-point buck a few weeks before his sixth birthday. Buck Tierney had been named Michigan’s outstanding high school athlete in 1970 and had gone on to play quarterback for the University of Michigan. From Michigan and a Rose Bowl win, he had gone on to Wayne State University Medical School, married a former Miss Ann Arbor, and had three picture-perfect children as he built a reputation as a top-notch surgeon. Buck had also remained in good shape, something he shrugged off when people mentioned it, but which he worked hard at in his fully equipped basement gym.
Even in his fifties, Buck looked like he could strap on the helmet and hold his own on the football field. When he wasn’t performing heart surgery, Tierney had applied his considerable athletic prowess to golf. As a result, he was a scratch golfer, or pretty close to it.
Buck Tierney honed his golfing skills at the old Lake Club, which was less well known than Augusta but at least as exclusive. The joke was if you didn’t know which lake—and there were plenty in the area—you couldn’t join. Tierney was one of the club’s 150 members. The roster was a who’s who of Michigan’s old money elite. The CEOs of Ford and GM were known to be members, prizing the club’s exclusivity and the course laid out around gorgeous Cavanaugh Lake. That Tierney, who came from an old Chelsea family, received an invitation to join when he was a young surgeon just getting his practice going was a testament to how effortlessly he moved in society’s rarefied circles. A benefactor who was a big college football fan covered his dues for the first five years, and the dues could be substantial. It all depended on what sort of maintenance and upkeep were required at the club. Some years, members were assessed eight thousand dollars. Other years, they were assessed eighty thousand. The bill was simply the club’s expenses divided by 150. As the saying went, if you had to ask…
Another of the club’s members was Morgan Smith, the hospital CEO and the club’s first African American member. Before signing on to run the hospital, Smith had made a fortune with a politically connected investment firm that catered to Detroit’s African American elite. His move to the hospital was viewed as the first step in a political career. Smith also loved golf, but he was a rotund man without Tierney’s physical gifts. Smith had spent his college days in the library, sweating out accounting, business administration, marketing, and the like when he wasn’t waiting tables. Smith was lucky if his golf score broke ninety, and that was with a couple of mulligans.
The two men would run into each other Saturday mornings in the clubhouse, and the chiseled Tierney would always invite the corpulent Smith to join him for a round. Smith would accept, and they would play a pleasant eighteen on what Golf Digest called “The Best Unknown Golf Course in America.”
Before a recent Saturday outing, Tierney had taken the unusual step of calling Smith on a Wednesday to arrange a golf date. Smith was surprised, curious, maybe even a little suspicious, but he jumped at any opportunity to spend eighteen holes with Tierney. He always enjoyed a chance to absorb some of the legendary Buck Tierney’s skills. So when the cardiac surgeon paused on the fourth tee, a 480-yard monster with a dogleg left, Smith was not surprised.
“You know, Morgan, I’m not getting any younger.” Tierney teed up his ball and launched a three-hundred-yard rocket down the fairway.
“Could have fooled me,” Smith said, laughing.
“Well, a man gets to be my age, he starts thinking about his legacy.”
“Don’t we all,” Smith said.
Smith teed his ball up, swung hard, and sent a ground bal
l skittering past a magnificent pine tree and into some thick underbrush.
“Take another one, Morgan. Try pausing at the top of your backswing.”
Smith put down another ball, followed Tierney’s direction and launched a high, straight drive down the fairway.
“Will you look at that,” Smith said.
“Not bad,” Tierney said, chuckling. They climbed in the cart. “As I was saying, I’ve been thinking about what will survive me, not only with my kids, but at the hospital.”
“Okay,” Smith said neutrally.
“Been talkin’ to some folks.” Tierney stopped the cart before they’d reached Smith’s drive. “I’ll put my cards on the table, Morgan. I think I can raise twenty million for a new cardiac wing. Do you think you can get the board to match that? Make Chelsea General the premier heart hospital in the Midwest.”
Smith took off his Lake Club cap and wiped his brow with his forearm. He was smiling.
“I don’t see why not.”
“Course, if you could see it in your heart to make it the Whitfield Bradford Tierney the Third Center for Cardiac Care, I would be grateful.”
“That’s a mouthful.”
“Has kind of a nice ring to it, don’t you think?”
“Hell, no one will know that’s you.”
“What are you suggesting?”
“How about the Buck Tierney Center for Cardiac Care?”
“Now you’re talkin’, Morgan.” Tierney chuckled, pushed down on the gas, and the cart moved down the fairway.
Back at the hospital the following week, Smith had scheduled a meeting of the board. Tierney and Smith were returning from an off-site meeting with the heads of marketing and public relations when Tina saw them and then rushed to catch up with Brenkovski. The news had hit her like a slap.
“Tina, you do not look happy about this,” Brenkovski said.
“I know cardiac care is a profitable service line, Nick, but don’t you think this will suck the air out of the room? If we’re solely a cardiac hospital, what does that mean for the rest of our patients, especially the ones who aren’t as well off? We’re not going to be investing much in anything else,” Tina said.
