Patient (12 page)

“Just keep up with blood loss, Byron,” Jessie said. “It’s still hard to predict, but I will say that I’ve seen worse.”

“You’re doing an incredible job,” Emily said. “Alex, I hope you have a good view of this, because you’re never going to see a gunshot case handled better.”

This time Jessie threw the elbow. She knew Emily was saying things just to keep her from getting too tense, but she was beginning to regret having confessed her newly evolving connection with the man.

“Quit it!” she whispered.

“A little advertising never hurt,” Emily whispered back.

The bullet had entered at a slightly upward angle, shattered the inner table of the skull, and ricocheted to a halt just to the left of the midline. Jessie recovered it with ease, then began cleaning away tissue that was clearly damaged beyond healing.

Maybe Jackie Robinson Terrell will throw again
, she was thinking at the moment the anesthesiologist said, “Everything all right? I’m getting a drop in pressure.”

“I don’t see—”

Jessie never finished the sentence. A sudden, continuous gush of dark, venous blood welled into the surgical field from beneath the posterior skull. Jessie’s heart rate rocketed.

“The occiput
was
fractured!” she cried out. “The torcular’s torn.” The bone fragments over the network of vital blood vessels had been held together so tightly by the bleeding and swelling around them that the CT scan hadn’t shown the fracture lines. “Byron, pump in every ounce of blood you have and send for more! Steve, let’s get the boy facedown immediately!”

“But the sterile field—”

“To hell with the sterile field! This child’s going out!”

“I need him supine if I’m going to be of any help in keeping his pressure up,” the anesthesiologist said.

“Byron, he’s got to be prone! If I can’t get at this bleeding, nothing you do matters. Scalpel, please. Scalpel, dammit!”

Frantically, with no attempt at continued sterility, Jessie cut away the posterior portion of Jackie Terrell’s scalp. The bone over the torcular was split down the middle, and blood was pouring out from the sinuses beneath it.

“Suck here, Steve! Em, you, too! Byron, we need more blood! Oh, Jesus!”

“The Doppler monitor on his chest is recording something,” Wong said. “I think it’s air in his heart.”

Jessie continued packing the bleeding area, but it was like trying to sandbag a waterfall.

“Pressure?” she asked.

“Forty. Jessie, there’s definitely air being sucked into his circulatory system. His heart’s filling with it.”

“Blood! We need volume!” Jessie ordered, unwilling yet to believe what she was hearing. “Put the table in Trendelenburg position. Adjust it until he’s not bleeding out or sucking in air!”

“Pressure zero,” Wong reported. “The air embolism is huge now. Heart rate is dropping. ... Flat line. We’ve got flat line.”

Jessie fought a few minutes more. Then she stared down at the blood, which continued to well up over her gloves but was now slightly frothy from the air that had been sucked through the damaged sinuses into the child’s circulatory system.

“That’s it,” she heard her voice say from a million miles away. “There’s no sense in continuing anymore.”

For a full minute, no one in the operating room moved. Then Jessie shook her head.

“I’m sorry, everyone,” she said hoarsely. “I’m really sorry. Each of you did a great job.”

ALONE IN HER Office, Jessie stared out her single window at a pair of swallows that had settled on her ledge. It had been hell telling Charlene Terrell that her son had died on the operating table—hell trying to explain to her that what ultimately killed her child couldn’t have been anticipated and couldn’t have been fixed.

One of the things Jessie had come to accept as a neurosurgeon was that many of her patients would never be perfectly, or even reasonably, intact after their surgery. All that was available to those cases and their families was to move the goal markers of their lives—the expectations—and to start over from wherever they could. But this—the inhuman senselessness of Jackie Terrell’s injury, the sudden, unforeseeable catastrophe in the OR—this was more pain than she ever wanted from her specialty. Gilbride, Tamika Bing, then Sara, and now this. Maybe it was time to consider moving to the lab for a while. Or maybe it was time simply to realize that she didn’t have the steel plating necessary to make it as a neurosurgeon. Lost in her thoughts, Jessie barely heard the gentle knock on her door.

“Yes, come in,” she said after clearing her throat. Alex Bishop slipped in and closed the door behind him.

“Hi.”

“Hi, yourself.”

“I thought maybe you could use a little cheering up.”

“A little cheering up might elevate me to miserable.”

Except for Emily, there was no one in Jessie’s world that she would want visiting her at this moment. Yet Alex Bishop, with his wonderful, troubled eyes, and his gentle voice, was a welcome sight.

“Your nurse told me there was no way anyone could have predicted that cracked bone when it didn’t show on the CT scan,” he said. “She told me you had saved that kid’s life, but when you removed the clot you also released the pressure that was holding the pieces together, and the crack opened up.”

“I guess.”

“It was awful for all of us to go through. It must be ten times as hard for you.”

“Thanks for understanding that. I’ll never get used to this sort of thing.”

“I hope you don’t.”

She put her hands on his, then stood and let him hold her for a time.

“I’m glad you came up here,” she said.

Chapter 15

JESSIE SPENT A RESTLESS NIGHT IN ONE OF THE tiny on-call rooms, rebreathing lungfuls of stale air and answering just enough phone calls to keep from reaching any deep, renewing sleep. She awoke for the last time at six, vaguely aware that she had been dreaming of Jackie Terrell racing through a brilliant, sunlit day over a carpet of emerald grass, chasing an endless succession of fly balls.

Throughout the evening, reporters had paged her to ask about the boy. They all were referred to the hospital’s public relations people, who read or faxed them a statement she had helped to prepare. Undoubtedly, Eastern Mass Medical Center would be on the front pages for the second time in a week. This time, it was doubtful the item would stimulate any three-million-dollar grants.

Jessie showered, pulled on a fresh set of scrubs, and tried a brief meditation. Still, as she headed over to the cafeteria for her usual in-house fare-sesame bagel with sliced tomato and cream cheese, coffee, and a banana—she felt unprepared for another frenetic round of post-Sheprow neurosurgical clinic. The four physicians she joined in the doctors’ dining room were engaged in what had become the standard, almost exclusive, mealtime conversation at the hospital—a  can-you-top-this of managed care horror stories and jokes.

Generally, Jessie’s zeal to make rounds on her patients and get her day going kept her from spending more than fifteen or twenty minutes with the breakfast crew. Today, although the stories and humor were as stale as the air in the on-call room, she couldn’t pull herself away. She even tried out a joke she had recently heard about the managed care executive who died and went to heaven, only to find out God had limited him to a three-day stay. The polite reaction from the others told her they had already heard it.

Finally, at seven-fifteen, she paged Emily and met her on Surgical Seven for rounds. Their patients were reasonably stable. As Jessie anticipated, Gary Garrison’s headaches had begun to abate. He was still frightened of a rebleed from his aneurysm, though, and jumped at her offer of one last day in the ICU. Dave Scolari’s hands and arms were making remarkable progress, and his legs were showing encouraging strength as well. A miracle. They were heading out of Dave’s room when Emily mentioned Jackie Terrell for the first time.

“Did you see the
Globe
this morning?” she asked.

“Nope.”

“They wrote about the heroic efforts of the doctors at Eastern Mass Medical.”

Jessie knew her friend well enough to leap ahead some steps.

“I’m okay about it, Em,” she said. “Honest, I am. I’m not blaming myself for something even the radiologist couldn’t see. It’s just so damn sad, that’s all.”

Emily put her arm around Jessie’s shoulder.

“I know, pal. I know it is. I went home last night and demanded that my kids turn off the tube and snuggle up with me on the couch for half an hour.”

“Good move. They’re great guys.”

“Speaking of guys ...”

Jessie smiled coyly and shrugged.

“Dunno,” she said.

“You do, too. I can see it all over your face. Did he come to see you after the case?”

“Maybe.”

“Ohmagosh, you really are bit, and it sounds like he might be, too. I think that’s great.”

“We’ll see. Look, I’m sorry for being in such a testy mood this morning. Gilbride’s off being famous again, so I’m facing another crazy day in outpatient. It’s like he opened this dam of referrals and then just swam away.”

They turned in to the next patient’s room, a tumor case of Gilbride’s. Jessie was surprised to see Lisa Brandon, the candy striper who had been with Sara, seated at the bedside.

“Evening shift one day, day shift another,” Jessie said. “Are you going for some sort of volunteer-of-the-year award?”

Lisa shifted uncomfortably.

“I hope it’s all right that I’m here again. Actually, there isn’t much for me to do at home, and I really like helping the patients.”

“In that case we’re lucky to have you. Work all three shifts if you want. Why not? I do.”

Jessie introduced Lisa to Emily as a leader in the don’t-know-what-to-do-when-I-grow-up club, and Emily proclaimed herself a founding mother of the organization.

“Cute kid,” Emily said after they had left the room.

“She’s no kid. She’s in her early twenties.”

“Have you looked at the birth date on your driver’s license lately, honey? She’s a kid.”

IT WAS MIDAFTERNOON. Jessie was in Carl Gilbride’s office waiting for Eastman Tolliver to join the two of them for what would essentially be catch-up rounds for Gilbride on his patients. He had returned from New York City a short while ago in triumph-a full ten minutes on the
Today
show, followed by an interview with the
Times
, a hastily called grand rounds presentation at Columbia Presbyterian, and a lunch meeting with a robotics manufacturer interested in cutting some sort of deal for ARTIE. Now, after finally telling his secretary to hold all calls, he was shamelessly pumping Jessie for any information that would give him an edge in his quest for a three-million-dollar grant.

“So what do you make of this guy?” he asked.

“Carl, I only spent an hour or so with him yesterday. He’s pleasant, and very interested in our program. That’s all I can say. I expected he might come in for rounds this morning—I invited him—but he called and said he’d wait until you got back.”

“Did he seem angry I wasn’t here?”

“Not really—at least not as far as I could tell. He seems very, I don’t know, Californian. Sort of laid-back.”

“Surely he must understand that I would never have left him hanging except that this was all very important stuff.”

“Critical. How many times does a body ever get invited to be on the
Today
show?”

“Exactly. So, what’s his background? What are his interests?”

“He hasn’t been at the MacIntosh Foundation all that long—six years, I think he said. Before that he was a college professor of some sort.”

“He’s bright, then?”

Bright enough to see through you, I fear
.

“Yes, that was my impression.”

“Mine, too,” Gilbride said. “I think we should—”

Gilbride was interrupted by his secretary buzzing in with the announcement that Tolliver had arrived. The foundation director strode into the office and greeted them both with vigor.

“Dr. Copeland, I’m terribly sorry to hear of that child’s death,” he said.

“Thank you,” Jessie replied, noting that her department chief hadn’t mentioned a word about the case.

“I was in your cafeteria and heard some people talking about what a heroic job you did by even getting the boy to the operating room.”

Jessie sighed.

“The whole thing is very tragic.”

Tragic
. The word seemed to galvanize Gilbride into action. It was as if he couldn’t stand to let any negative connotation hang in the air.

“So, Eastman,” he said, clearing his throat for a transition, “what do you think of what you’ve seen so far?”

Tolliver’s expression flickered annoyance at Gilbride’s inappropriate lack of subtlety. Jessie was as certain she saw the reaction as she was that her chief hadn’t.

“So far, so good,” he said. “But I’m still anxious to learn more about ARTIE, and to watch him in action.”

“Well, I can’t say that I blame you,” Gilbride said. “I believe we are seeing the future of neurosurgery—perhaps even of all surgery—in our little robot.”

“Have you experienced any problems with the device?”

“Some mechanical glitches, but nothing major.”—Unseen by either man, Jessie rolled her eyes.—“Even though we’re doing cases now with ARTIE,” Gilbride went on, “we’re still working with him in the lab. The search for perfection isn’t just the motto of our research unit, it’s the rule. We see the next generation of the device being even smaller, more maneuverable, and more powerful than the one we’re using. I believe it’s no exaggeration to say that at some point, not that far down the road, the surgeon interface between the robot and the MRI may be eliminated altogether. The device could simply be inserted beneath the patient’s skull and turned loose, as it were.”

“Sounds like something straight out of science fiction,” Tolliver said.

“So were Jules Verne’s submarine and rocket to the moon,” Gilbride responded, now clearly on a roll. “MRI-assisted surgery is merely in its infancy. The future is limitless.”

Jessie felt her gut knot. Just a short while ago, a mechanical malfunction had caused ARTIE to rip into the normal brain tissue of her cadaver-subject. Still, she knew better than to so much as mist on Gilbride’s three-million-dollar parade—at least not until she was ready to start searching for a new position. If Gilbride wanted to compare himself as visionary with Jules Verne, so be it.

“Well,” Tolliver said, “you certainly make a good case for your invention. However, before I return to California, I would hope to see this ARTIE perform an actual operation. Is that possible?”

Gilbride’s bluff had been called. Not surprisingly to Jessie, Eastman Tolliver had no intention of buying a pig in a poke. If the MacIntosh Foundation was going to lay heavy money on a device, he wanted to see it in action. Jessie knew what was coming next.

“So, Jessie,” Gilbride said, turning to her, “you have my OR schedule. Are there any cases appropriate for ARTIE?”

No, Carl. As a matter of fact, at this stage of the game, there are no cases anywhere that are appropriate for ARTIE.

“Actually, Emily has the OR schedule. We’ll be meeting her in the ICU. You can decide for yourself once you’ve gone over it and met your new patients.”

“And I shall.” Once again Carl cleared his throat, signaling he was about to transition. “So, then, shall we make our way to the ICU?”

ROUNDS BEGAN SMOOTHLY enough, with Gilbride at his bombastic best, leading an entourage that included Jessie, Emily, two other nurses, two medical students, two residents, and the foundation director on a leisurely patient-by-patient tour—first of the unit, then of the rest of the floor.

By and large, Gilbride’s patients were docile and seemed happy to have their surgeon back and grateful he had stopped in to see them. There were, however, three of the sharper ones who made snide or angry remarks about his lack of involvement in their cases. Jessie wasn’t certain whether the cynicism was ignored by Gilbride or simply went over his head. But the jab of one elderly patient, Clara Gittleson, clearly hit home.

“Dr. Gilbride,” she said crisply, “I have to tell you that I never knew how little attention you were paying to me until Dr. Copeland and Emily started coming around.”

Gilbride mumbled something that might have been an apology. A nerve twitched at the corner of his mouth. He asked Jessie a number of questions about the woman’s post-op mental status. Finally, he suggested that a psych consult might be in order to deal with what was obviously a combination of depression and reaction to post-op medications. Jessie glanced over at Tolliver, who seemed unaffected by the exchange but remained steadily focused on Gilbride.

As they headed for the next room—Rolf Hermann’s—Jessie lagged back and subtly motioned for Emily to join her.

“Have you been in to see Orlis yet?” she whispered.

“Dragon Lady? Oh, yes. I stopped by a few hours ago while I was checking to make sure everything was in place for the emperor’s return. She wanted to see me about as much as she wants to see a zit on that perfect face of hers.” Emily adopted a passable German accent and added, “I vish only to speak viz Ducktor Geelbride.”

“Well, Orlis, be careful what you wish for. You just might get it.”

“I can hardly wait.”

“Dr. Copeland,” Gilbride called out from outside the door, “would you mind terribly continuing on rounds with us?”

Jessie hurried up to the group, presenting the next patient as she arrived.

“Count Rolf Hermann is a fifty-three-year-old married German man, the father of three, who was perfectly healthy until he experienced the first of two seizures about six weeks ago. Evaluation in Europe led to these MRIs.”

Jessie knew better than to upstage Gilbride by identifying the tumor or giving any clinical opinions. Instead, she merely nodded to Emily, who took Hermann’s MRIs off a stainless steel rolling cart and slid them onto two of the view boxes inset in the wall across from his room. Gilbride’s thoughtful pacing back and forth in front of the films was clearly for the benefit of Tolliver and perhaps the medical students, because all of the others could have made the correct diagnosis from a passing train.

“Well,” he said finally, “it appears what we have here is a large subfrontal meningioma, wouldn’t you say, Dr. Copeland?”

“I would, yes, sir.”

“Well, what do you think of this tumor as appropriate for our intraoperative MRI with robotic assist?”

Jessie knew that if any case was ideal for ARTIE, this one was. But she still had serious reservations.

“I think ARTIE would be one way of getting at it,” she said, choosing her words carefully.

“Excellent. We’re in agreement, then. Mr. Tolliver, here’s your case. Dr. Copeland, is there anything else you think I should know about this fellow?”

“Not really.”

“Well, then, let’s go meet the man.”

“He speaks some English,” Jessie said, “and understands it completely, but his wife does most of the talking.”

The room, which was large for a single, was packed even before the arrival of the medical entourage, with Orlis, her husband, and his three grown children sharing space with a considerably overweight private-duty nurse. Jessie introduced Gilbride, feeling as if she were passing off the baton in a barefoot relay race across hot coals.

“Well, it’s a pleasure indeed to meet you,” Gilbride said. “However, before we conduct our business, I must ask your children and nurse to wait in the hall. We are a teaching hospital, and after I bring everyone in who is making rounds with me today, I’m afraid this room will get a bit crowded.”

“You will not be bringing everyone in,” Orlis responded. “Count Hermann will not take part in any medical circus.”