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Tuesday, April 7, 10:43
A.M.

D
espite her exhaustion, Lynn had taken a short detour to the cafeteria. After leaving Michael she reluctantly decided that hunger had trumped her lack of sleep. The calories from the banana and bread roll she had eaten en route to the meeting with Wykoff had quickly disappeared. She felt weak, a little dizzy, and even a bit nauseous.

With little fear of running into any of her close friends, because of the derm clinic, she opted to sit down at a table. Sensing she needed some protein, she ordered scrambled eggs and wolfed them down with a cup of herbal tea. The food helped enormously, and made her believe she could think much more rationally and less emotionally. It also made her dizziness and nausea go away, something she noticed particularly as she headed over to the dorm, passing literally and figuratively in the shadow of the hulking Shapiro Institute.

Just as she had done the previous day, she paused for a few moments, eyeing the structure. She thought about Scarlett Morrison being transferred into the institute, and the idea brought up the
issue of Carl being sent over as well. She questioned what she would do if that happened, as she wasn’t family. It would mean she’d be reduced to getting updates from his parents. They had been gracious when she ran into them the day before, but that could change when they remembered that she had been the one to recommend he have his surgery at the Mason-Dixon rather than the Roper Hospital at MUSC. She might be left out in the cold. Lynn shrugged. She knew she was getting way ahead of herself. With a sense of resignation, she continued toward the dorm.

It felt weird going into Michael’s room without him. After closing the door behind her, she stood for a moment, taking in the familiar sights and aroma. Michael was far neater than she, and everything was in its place. Even the books were shelved according to subject matter. Over the years she had teased him about the fastidiousness in his lifestyle, just as he had given her grief about her lack of it.

Although it was a bit strange to be in the room without Michael, just being there also felt comforting. She had spent considerable time in his room, as he had in hers. Especially during the first two years, they had studied a lot together in one or the other’s room. Many of the other students had preferred the library or the student center for communal learning. Not Lynn and Michael. What made studying together so rewarding was that they silently pushed each other to make greater efforts than what they would have had they studied on their own.

She sat down at Michael’s computer. He had cobbled it together from various components to maximize the gaming experience. She had gone through a gaming period herself but had grown out of it. Not so with Michael. She knew that he still used it to relieve anxiety and difficult emotions that medical school was capable of engendering, especially for a black man in a southern, mostly white professionally staffed medical center. He had admitted to her that he often gamed for fifteen minutes or so late at night, explaining that when
he was a teenager, gaming had been a much-needed escape from the pressures of the ’hood, and a way of dealing with aggression.

After turning on the system, Lynn pulled up pictures. Expecting to find a well-organized and well-thought-out photo filing system as further evidence of his compulsiveness, she found something quite different. The photos were organized merely by date, meaning the chronological order in which the photos were taken.

Remembering that Ashanti had had her surgery several months earlier, Lynn started looking at photos taken in January. To her surprise, she came across a series of pictures that had been taken on a Saturday-afternoon excursion to the gorgeous Middleton Place, the apparent namesake of Middleton Healthcare, a sixty-acre landscaped garden begun as a rice plantation in the seventeenth century and now listed as a National Historic Landmark. Michael, his girlfriend, Kianna, Carl, and she had gone.

Lynn’s breath caught as she found herself looking at a photo of herself and Carl and Kianna in a horse-drawn carriage. Michael was not in the photo because he was the photographer. It was a happier time: a sublime time.

For a second Lynn closed her eyes and let the reality of Carl’s coma flood her thoughts. She had been getting by on a ton of denial and intellectualization, but now the realization that his mind and memories were gone descended on her like an avalanche. For the first time since the tragedy had begun, she let herself be enveloped by raw emotion. She began to cry. And cry she did, with shuddering intensity like a summer thunderstorm.

After what seemed like an eternity, the tears slowed. Eventually Lynn managed to get up and get some toilet paper to dry her cheeks and blot her eyelids. The small amount of makeup she used came off in a dark, dirty smudge.

Regaining a semblance of control, she went back to shuffling through Michael’s extensive photo collection, avoiding pictures of Carl and herself as much as possible. It was difficult because there
were a lot. She had forgotten they had double-dated with Michael and Kianna quite so often. There were photos of all sorts of things, including hundreds of shots of Charleston historic houses.

Eventually Lynn found the image she’d been searching for and brought it up onto the screen. It was entirely readable, especially since its compression had been slight, and she was able to enlarge sections. Satisfied, she e-mailed the image to herself in a large format. She wanted to preserve her ability to look at the details, particularly his vital signs. A moment later she heard the phone in her pocket announce she’d gotten the e-mail.

Lynn was back in her room a few minutes later. She took off her white coat and draped it over the reading chair, which also contained a ball of recently washed clothes. It always took her time to sort through the bundle when she brought it up from the laundry room in the basement. Sometimes she didn’t bother. On those occasions she just used the clothes as they were needed.

For a moment Lynn eyed her bed, which she made only when she washed her sheets, which wasn’t often. She had always thought she had better use for her time. Briefly Lynn considered lying down for just a few moments. Then she changed her mind. She knew that once she was horizontal, it might be difficult to get up.

Instead she sat down at her laptop and went into her e-mail inbox. There at the top was the JPEG she’d just sent to herself. Immediately below were two other e-mails from Michael. As promised, they were Scarlett Morrison’s and Carl’s anesthesia records. Lynn checked to be sure. Then she loaded all three into a flash drive, which she would take down to the student common room on the first floor to utilize the communal printer. But before doing so, she Googled
gammopathy
as she had done in the neuro ICU and immediately found the same article: “Monoclonal Gammopathy of Undetermined Significance.” She downloaded a PDF version into the same USB device. Then she downloaded Wikipedia articles on multiple myeloma and serum protein electrophoresis. The last
article she knew she wanted was on monoclonal antibodies, but when she rapidly read through it before downloading it, she realized there was one more she needed. It was on hybridoma technology. From an immunology lecture in her second year she remembered that monoclonal antibodies were made by hybridomas.

So armed, Lynn went down to use the printer. She had to swipe the magnetic tape on her student ID to get the machine to operate. While the machine did its thing, she sat in one of the leather club chairs and practically fell asleep.

With her printouts in hand, she went back to her room and lay down on her bed. For a few minutes she debated which of the printed pages she should read first. She thought about looking at the anesthesia records but decided she needed a completely clear head for those. Instead she turned to the articles. She settled on the gammopathy article, since it would be a review, as she had already read it once before in the neuro ICU. After that, she planned to read the one on multiple myeloma. But the reality was that she managed only four or five sentences of the first article before falling into a deep, dreamless sleep.

Tuesday, April 7, 1:52
P.M.

W
ith a sense of relief Sandra Wykoff left the PACU after making sure her second and final case was fully awake and functioning normally. It had been a hip replacement, and she was confident the patient would be going back to the fifth floor in short order. During both cases, when it came time for her to wake them up, she’d had a degree of anxiety, but both had awakened as expected, just as all the other cases she had done in her career, except for Carl Vandermeer’s.

Once out in the main hallway, Sandra walked down to check the whiteboard to make sure she had not been scheduled for another case since her first case had been canceled. Although she was confident Geraldine Montgomery, the OR supervisor, would have let her know, she wanted to be certain. After the tongue-lashing she’d suffered from Benton Rhodes that morning, she wanted to be absolutely certain she didn’t do anything to provoke the man further. She had known about his reputation for having a short fuse but until that morning had never experienced it personally.

The more Sandra thought about the Vandermeer case, the less
harsh she became on herself. She was absolutely confident that she hadn’t done anything wrong during the procedure. She had not even taken so much as a shortcut, which she knew other people in the department did on occasion, particularly neglecting to manually check the anesthesia machine before each use. Most relied completely on the automatic check, which she thought was a mistake.

It had taken only a little more than an hour after Rhodes had stormed out of the communal OR anesthesia office for Sandra to be again totally convinced that whatever had happened during the Vandermeer operation was not her fault. She was absolutely sure of this, since she had, as she had told the students, gone back over the case in minute detail, questioning every step and consulting with several other anesthesiologists whose opinion she admired and trusted.

Sandra had even tried to have a conversation with Mark Pearlman, who had had a strikingly similar case the previous Friday, but he had refused to talk with her about his case or hers. He had chosen to follow Rhodes and Hartley’s orders to the letter, even to the extent of not talking to a fellow anesthesiologist. Sandra thought that was a mistake despite what the hospital counsel felt. She knew that complications often led to advances in medicine.

The long and short of it was that if there was a lawsuit, Sandra was confident that no one would find the hospital or herself culpable. And, contrary to what Benton Rhodes had said, she was sure that the two students were Mason-Dixon family and could be trusted. She had made the effort to call the dean of students to ask about Lynn Peirce prior to seeing her and had learned that Miss Peirce was going to graduate number one in her class, just as Sandra had done over at MUSC almost seven years before. There had been no reason not to talk to her and her classmate and perhaps salvage something from the disaster. Students had to learn that medicine was not all-powerful or completely predictable.

And there had been a positive aspect to the conversation with
the students. For Sandra, talking about the case in detail had helped ameliorate the guilt that had been haunting her since the tragedy had struck and boost her confidence in her professional abilities. Confidence was important if she was to continue being an anesthesiologist.

The other thing the conversation with the students had done was remind her of the blip that had occurred on the monitor. It had been so insignificant, but considering it was the only thing about the case that was at all unusual, she now thought it was worth checking. The problem was that doing so necessitated calling Clinical Engineering, something she was reluctant to do, since it meant risking having to deal with Misha Zotov.

Steeling herself against such a possibility, Sandra walked back down the main OR corridor whence she had come and headed for the room where the extra anesthesia machines were stored. Her hope was to corral one of the Clinical Engineering technicians and ask a few questions about the blip she’d seen on the monitor. She wasn’t looking forward to going all the way down to the Clinical Engineering Department, located in the hospital basement, where she had first encountered the irritating Russian.

The good news was that Misha Zotov wasn’t in the room. The bad news was that no one else was, either. Turning around, Sandra retraced her steps to the main desk. It seemed that if she was going to ask about the blip, she would have to go to the Clinical Engineering office, after all.

At the busy main desk, Sandra got Geraldine’s attention and told her she was leaving the floor and that if she was needed for anything, she could be texted. Geraldine gave her a thumbs-up to indicate she got the message.

After retrieving a long white lab coat from her locker in the women’s lounge, Sandra was able to put off going down to the basement, at least for the time being. Thinking about Carl Vandermeer made her want to check on the man’s status. She had gone into the
neuro ICU for a quick visit the previous afternoon before leaving the hospital and also early that morning on her way in to work. Although she was aware of the MRI and CT scan results and had read the neurology residents’ notes, she couldn’t help but harbor a bit of hope that there might be a change for the better, knowing how little hypoxia he had suffered.

Once in the neuro ICU, she went directly to cubicle 8. Seeing Carl, Sandra could immediately tell there had been no change in his condition. A nurse had rolled him onto his left side so that she could wash and powder his back. Sandra shuddered at the enormity of the situation for which she, on some level, was responsible for causing. She knew that dealing with a comatose patient required almost constant care and attention. She also knew that Carl would probably need a percutaneous gastric tube. Doing so required an operation. Sandra shuddered again, wondering how she would feel if it fell to her to do the anesthesia.

“Any improvement?” Sandra asked, even though she already knew the answer.

“Oh, yeah,” the nurse said optimistically. “He’s doing okay. A few minutes ago he sneezed.”

Good grief
, Sandra thought but didn’t say. The patient’s having a sneeze was such a pathetic indication that Carl was doing okay. At the same time she understood that a sneeze was a positive sign, as it meant that at least the brain stem was functioning. She glanced up at the monitor. The temperature was elevated, as it had been that morning, but everything else was normal. She then left the cubicle and headed over to the central desk. En route she noticed that Scarlett Morrison, Mark’s coma case, was gone, as her cubicle was occupied by a man named Charles Humphries.

The previous afternoon she had had a short conversation with the head nurse, Gwen Murphy, about Carl, and again Sandra sought her out. “Any change with Vandermeer?” she asked, a bit of hope against hope.

“Nope,” Gwen said. “But on the bright side he is very stable. And the infectious disease consult hasn’t found any infection to explain his elevated temperature. And the fever has come down a bit.”

Sandra looked over at the cubicle where Mark Pearlman’s case had been. “I see Scarlett Morrison is gone. Did she go out to the neuro floor?”

“Nope!” Gwen repeated. “They took her directly to the Shapiro Institute. To be honest, they don’t really have the equipment or the manpower out on the neuro floor to handle a long-term comatose patient. At the Shapiro they are specifically set up to do it.”

“Seems awfully quick,” Sandra said. “She was here only three days.”

“As stable as she was, she didn’t need to be here in the ICU,” Gwen said. “And it’s better for everyone, the patient included, and the hospital bean counters also like it. Keeping someone here in the neuro ICU is ten times more expensive than it is over there.”

“Ten times! Wow! I knew there was a difference but not that much. That’s quite a stimulus.”

“It sure is. We’re hoping Vandermeer goes, too.”

“Really?” Sandra said with dismay. “But he just got here. Maybe he is going to improve.” In her mind, sending a patient over to the Shapiro Institute meant “pulling the plug” on hope, even if hope was unrealistic.

Gwen shrugged. “Not according to the neuro residents. It’s their feeling that getting him over to the Shapiro sooner rather than later is indicated, and we surely could use the bed.”

Feeling more depressed leaving the neuro ICU than she had when she had arrived, Sandra went back to the main elevators. She squeezed into the next down car as she had run out of excuses for postponing a visit to Clinical Engineering. Although the elevator was jammed when she boarded, descending from the first floor to the basement she was the only person left. When the elevator doors opened, she paused for a moment. Then she shook her head, feeling
embarrassed at her timidity. If she ran into Zotov, she would just ignore him. She thought she was acting like a teenager.

Sandra first passed the Pathology Department and the morgue, and then the Informational Technology Department, where the hospital’s servers could be seen in their air-conditioned isolation. Next to IT was the central security office, and Sandra caught a glimpse of the banks of monitors fed by cameras sprinkled all over the medical center.

As she walked, Sandra reflected on why Misha Zotov bothered her so much. He reminded her of her ex-husband, Adam Radic, in both looks and mannerisms. Both were darkly complected, tall, muscular but slender with intense, lidded eyes and heavy beards. Both were also fawning to the point of overdoing it. With Adam, time had proved it had been an elaborate act. Somehow she was certain it would be the same with Misha.

Initially, when Sandra had first met Adam at the very beginning of her residency, she had been quite taken by his flattery and attention. She also had found him exotically attractive and much more sophisticated than she, having traveled and studied around Europe. He had come to America from Serbia to do a surgical fellowship. Believing his declarations of love were sincere, Sandra had fallen in love with him. For a highly motivated doctor like herself, it helped that he was a recognized and talented surgeon.

Within less than a year after they had started dating, she and Adam were married. But after the marriage things quickly changed, especially once Adam got his green card. He became a tyrant and had beaten her severely several times. Thanks to her father’s intercession, Sandra got divorced, but not without suffering considerable trauma. For her, the issue of domestic violence had become a distinct reality.

Sandra pushed through the door into Clinical Engineering. It was a large room with service benches piled with a mixture of all manner of hospital apparatuses, from anesthesia machines to
respirators. It was all neat and orderly, with tools on Peg-Boards. The noise level was moderate, with various power tools competing with a background of classical music. At a table against the back wall two men played chess.

As Sandra’s eyes swept the room she estimated that there were about fifteen people at work, all dressed in white coveralls. Most continued doing what they were doing. A few looked up. Most of them resembled Misha Zotov. There were a few blond men, but they were a distinct minority. There were no women.

To Sandra’s mild dismay, Misha Zotov was one of those who looked up, as he was at the closest service bench, working on an anesthesia machine. She caught an expression of recognition on his face, and to her chagrin he immediately put down the tool he was using, stood, and started toward her.

Sandra’s eyes quickly scanned the room again, this time looking for Fyodor Rozovsky, the department supervisor. She had met him on her previous visit. It had been he who had answered her service-related question. Unfortunately he was nowhere to be seen.

“Ah, Dr. Wykoff,” Misha said, crowding her space. It sounded as if his English had improved, but he still spoke with a distinctive Russian accent. “You look beautiful. How can I help you?”

“Where is Fyodor Rozovsky?” Sandra asked. She took a step back, avoiding eye contact with the man. By inappropriately and presumably insincerely referring to her appearance, she could tell he had not mended his ways. She wanted nothing to do with the man. She glanced around the room yet again.

“He is in his office,” Misha said. “Please! I could get him for you. No trouble at all.”

“Thank you, but I’ll find him myself,” Sandra said curtly, and headed off. The office was in the back. Unfortunately Misha did not get the message and tagged along, continuing to try to engage her in conversation. Whether she answered or not didn’t make a difference. He was carrying on about the weather and how beautiful it was in
Charleston with all the flowers and how bad it was in his hometown in Russia this time of the year. His English vocabulary had definitely expanded.

Sandra didn’t respond. It was amazing how much the man reminded her of Adam Radic, and the memory made her skin crawl. When she got to the door to the office, Misha was still behind her. The fact that she was ignoring him had no effect on him whatsoever. He was again suggesting they have a drink together at his favorite bar on the rooftop of the Vendue Inn, saying it was a great place to watch the sunset over the Charleston skyline. Sandra knew of the bar. It had been one of Adam’s favorite hangouts, but without her.

Sandra went into Rozovsky’s office. Without breaking a step, Misha accompanied her. Inside the office were a small service bench and several desks. One was occupied by the Clinical Engineering supervisor, and the others were empty.

Before Sandra could say anything, Misha pushed past her and engaged Fyodor in an animated conversation in Russian. Fyodor peered around Misha as Misha spoke. Sandra wondered what in God’s name Misha was talking about since she’d said next to nothing to him. Finally Misha finished and stepped to the side. Fyodor stood up and gestured to the straight-back chair Misha proceeded to pull over. “Please, Dr. Wykoff, sit down.” In contrast to Misha, he spoke with very little accent, and his English was very good. “I remember you. You came down to ask how often we did routine service on the anesthesia machines.”