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Monday, April 6, 9:48
A.M.

L
ynn moved quickly toward the main bank of elevators. It was crowded as it always was at that time in the morning, especially on a Monday morning. Lynn was well aware that the hospital, along with Medical University of South Carolina on the other side of town, served as the tertiary-care centers for the metropolitan area, with a population soon to be pushing a million. Charleston was growing, as its manufacturing and biotech base expanded, particularly in the northern suburbs. Boeing was enlarging its 787 assembly plant, and the multinational drug giant, Sidereal Pharmaceuticals, had just announced it was adding a thousand new jobs to its expanding biologics manufacturing plant.

There was another reason the hospital was busy. Answering what was considered a national need, Middleton Healthcare had built a state-of-the-art facility, called the Shapiro Institute, for the care of persistent vegetative state, or PVS, and had physically connected it to the Mason-Dixon University Medical Center. It had been built with a huge philanthropic grant from Sidereal Pharmaceuticals. Although the institute was for the most part self-contained, it did
use the center’s clinical laboratory and operating rooms when necessary. Although Lynn and her buddies knew little about the establishment, since it was not used for teaching purposes, she did know that patients from all over the United States arrived on a regular basis along with their families and were admitted through the hospital.

During her second year of medical school Lynn and her fellow classmates had been given one visit, presumably to encourage them to refer their vegetative patients to the facility when they went into practice. Their guide was one of the institute’s hospitalists, but the tour had been very limited. Its purpose was mainly to impress upon the medical students how computerized and mechanized the place was, and how that made it possible to take care of so many patients with so little staff.

Accustomed to multitasking, Lynn slipped her computer tablet out of its pocket as she hustled along and entered Carl’s name to get his room number. When no number came up, she wasn’t concerned. She knew how the system worked. On day-of-surgery admissions, a room wasn’t assigned until the patient was ready to leave the PACU. That meant that Carl was probably still there. But sometimes during the busy morning hours, data entry for room assignments lagged as much as an hour behind more important data entry. Even without a specific room, she was not going to go to the PACU. It was one of the areas of the hospital that medical students were discouraged from visiting, even when rotating on surgery during their third year. Instead Lynn would head up to the fifth floor, where orthopedic cases were sent after surgery, provided a room was available.

“Excuse me,” a pleasant voice said amid the general din. At the same moment Lynn felt a tug on her arm and found herself looking down at an older woman with blue-tinted white hair. At five feet ten inches tall, Lynn looked down on a lot of women. “Can you help
me, Doctor?” the woman added when she had Lynn’s attention. She was clutching some lab slips.

“I’m not a doctor yet,” Lynn said. Lynn was honest to a fault. “But how can I help?”

“You look like a doctor to me even if you are much too young. I need to have some blood work done, but I don’t know where to go. They told me at the front desk, but I’ve already forgotten.”

For a moment Lynn hesitated. If she was still going to be in time to welcome Carl, she needed to get herself up to the fifth floor. Yet, sensing the woman’s panic, she relented. “Of course I’ll show you.” Lynn took the woman’s free hand and marched her back the way they had come. From the main entrance foyer, they crossed over the connecting bridge into the outpatient clinic building. Once inside, Lynn took the woman to see one of the clerks behind the main check-in desk.

“I will be happy to show this young lady where she needs to be,” the clerk said.

Lynn quickly retraced her steps, and after a short wait, boarded one of the main elevators on her way up to five. Unfortunately it was a local, stopping at every floor to discharge or pick up people. Pressed into the back of the car, Lynn tried again with her tablet to see if Carl had been assigned a room yet, but he hadn’t. She expected it was going to happen at any moment.

Once on five, she went directly to the main desk. Like the rest of the hospital, the floor could not have been any busier. To add to the chaos, the breakfast trays were in the process of being collected. The nurses who had long since finished report were getting some patients down to surgery, welcoming others back from the PACU, attending to doctors’ orders, distributing medications, and arranging transportation to radiology and physical therapy. It was comparative bedlam.

Lynn knew many of the people who worked on the floor from
her monthlong elective back in October. She looked for the head nurse, Colleen McPherson, with whom she had gotten along well, but didn’t see her. When she asked another floor nurse, she learned that Colleen was in with a hip replacement patient whom they were trying to mobilize. Instead Lynn went back behind the desk to chat with Hank Thompson, the ward clerk. In the hospital hierarchy run by the nurses, medical students were low on the totem pole, but Hank had never treated her that way. He was a student at the College of Charleston and doing his own version of a work-study program.

Like everyone else, Hank was doing six things at once. He was on the phone, with a number of people on hold. While waiting, Lynn pulled up the master list of all the patients on the fifth floor on one of the monitors. It was organized according to room number. She ran her finger down all the names, looking for Vandermeer. It wasn’t there. But there were several vacant rooms, so she thought there wasn’t going to be a problem. She was pleased. It was best for orthopedic patients to be on the fifth floor because the nurses and aides were well versed in handling the usual problems that had to be faced by post-operative orthopedic patients, like dealing with the CPM, or continuous passive motion machines, which flexed and extended joints immediately after surgery. Lynn knew that Carl would have one because Weaver used them with all his ACL cases.

When Hank finished with the people on hold, he started to punch in the numbers to make another call. Lynn grabbed his arm.

“Two seconds of your time, Hank! A patient by the name of Carl Vandermeer will be coming to the floor shortly, unless he is already here. Does the name ring a bell?”

“Not that I remember,” Hank said with a shake of his head. “Who’s the doctor?”

“Weaver.”

Hank grabbed the master OR list and scanned it. “Yeah, here it
is. It was a seven-thirty case.” He looked at his watch. “Should be coming up any minute, unless there was a complication.”

“It was a straightforward case. First operation. Healthy, young guy.”

“Shouldn’t be a problem. We have several rooms vacated this morning, and they have already been serviced, so they are clean and waiting.”

Lynn nodded and absently played with a paper clip. Hank turned his attention back to the phone. It occupied 90 percent of his day every day.

Lynn knew she should probably head over to the eye clinic. The lecture would be over and patients were probably lined up to be presented and examined by the medical students. Yet she knew she wouldn’t be able to concentrate until she was certain Carl was comfortable and all was in order.

Suddenly she stood up. Feeling she couldn’t just sit there, she decided she’d go down to the second floor and at least check the OR schedule. There could have been a delay in getting started. What if Weaver had come in late for some reason? What if the OR was short of nurses? There could be millions of reasons why a case could be delayed.

Lynn took an elevator down three floors. Feeling a bit like a fish out of water, she walked into the surgical lounge. It was another one of those places medical students didn’t wander around unaccompanied. Like the rest of the hospital, it too was crowded, since the OR was in full swing. Most or all of the lounge-style chairs and couches were occupied by doctors and nurses. All were in scrubs. A TV in the corner was tuned to CNN with the volume turned way down. Most people were reading newspapers, either waiting to begin or taking a quick break in the middle of cases already under way.

Fearful of calling attention to herself and possibly being ordered to leave, Lynn didn’t hesitate. She stepped into the room far
enough to see the image of the OR white board in the monitor mounted on the wall. She looked for Weaver’s name and found it in OR 12. He was doing an anterior cruciate ligament, all right, but the patient’s name was Harper Landry, not Carl Vandermeer. So obviously Carl’s case was over.

Lynn’s eyes scanned around the room for a familiar face, somebody, anybody she might know however vaguely from either her orthopedic elective or from third-year surgery. But she didn’t recognize anyone. With sudden resolve she went into the women’s changing room.

Getting some scrubs, she changed quickly, using an empty locker for her clothes. After tucking her moderately long hair into a cap and grabbing a surgical mask, she checked herself in the mirror. The almost-white surgical hat emphasized her olive complexion, and without the benefit of her thick hair to frame her face, she thought her youthful, angled features and slightly upturned nose made her appear younger than she was. Combined with her height, she worried she was going to stand out like a sore thumb as a first-year medical student who didn’t belong. More to conceal her identity than to be aseptic, she put on the mask.

Satisfied, she returned to the lounge. Without hesitating, for fear she would lose her nerve, as Lynn generally followed rules, she walked out of the lounge and pushed her way through the double doors into the OR suite. She had been there before on numerous occasions during her monthlong orthopedic elective and even a few times during third-year surgery, but always accompanied. She had even assisted Weaver as well as a few other surgeons to get a close-up idea of orthopedic surgery. To her, orthopedic surgery was a lot different from what Karen had suggested. It wasn’t eye surgery, to be sure, but with newer tools it was considerably more precise than it had been.

Lynn half expected that she would be challenged, but she wasn’t.
She kept moving at a good clip with the belief that any hesitation on her part would be a tip-off that she was an interloper. Her destination was the PACU, and she headed directly for it. She pushed through the second set of double swinging doors as if she belonged, but then stopped a few feet inside the room.

For most people, Lynn included, the PACU was a busy, alien world of high tech, which made students feel incompetent. The patients were on elevated beds with side rails. Most of the beds were occupied. There were no dividers between the beds. Each seemingly sleeping patient had at least one nurse, many with a nursing assistant as well. Fresh bandages covered varying areas of the patients’ bodies. Clusters of intravenous containers that appeared like plastic fruit hung on the tops of metal poles. The lines snaked down to run mostly into exposed arms, although a few were central lines going into the neck. Monitors were clustered on the wall over the head of each bed, with various electronic blips tracing lines across their screens. Plastic bags hung under the beds for drainage and urine. Several of the patients had ventilators for assisted respiration. The sounds in the room were a mixture of the electronic beeping, the cycling of respirators, muted voices of the nurses, and a low hum of powerful HVAC motors keeping the air in the room clean and cool.

Right behind Lynn, a gurney came crashing through the swinging doors, bringing in a fresh post-op patient and making Lynn jump out of the way. An OR nurse was pulling at the front. In the back was an anesthetist pushing while making sure that the patient’s breathing was not being compromised. A nurse from behind the central desk came around to help guide the gurney alongside an empty bed.

As the patient was efficiently moved from the gurney onto the bed, Lynn took a quick loop around the room, trying not to be conspicuous. None of the staff seemed to notice her. Carl was not there. She would have recognized him immediately. There were two people
who had had knee surgery with CPM machines to keep their knees constantly flexing and extending. Neither was Carl.

Confused and not knowing exactly what to do, Lynn wandered over to the counter facing the central desk. She assumed she would soon be challenged, but felt it no longer made a difference. If Carl was not in the PACU or on the fifth floor, then where the hell was he? And why was he not on the orthopedic floor? There were beds available, according to Hank. Of course maybe Carl had been finished so soon that it was before the beds on five were ready. Hank had said that they had been vacated just that morning. Lynn felt that had to be the explanation. Yet the ongoing mystery was starting to upset her, fanning the subliminal tension she had felt upon awakening that morning, the same tension that had made her laugh so hard at Ronald’s off-color joke about the angel.

“Can I help you?” a voice questioned.

Lynn turned to face a PACU nurse almost as tall as she. The nurse was gowned over her scrubs. She regarded Lynn with a questioning, steady gaze.

“I hope so,” Lynn said. “I’m looking for Dr. Weaver’s first case. A man named Carl Vandermeer.”

“And who are you?” The woman’s voice wasn’t challenging or truculent, just authoritative.

“I’m Lynn Peirce, a medical student. I did a rotation in orthopedics and scrubbed with Dr. Weaver.” It was the first thought that came to her mind. It wasn’t a real explanation, but it sounded good.

The nurse eyed Lynn for a moment, then went behind the desk. “The name is not familiar to me,” she said. She took a quick look at the PACU log and found it. “He was Gloria’s case,” she said to Lynn, and then called loudly across the room. “Gloria! What was the dispensation of the Vandermeer case?”

“The neuro consult guys took him to the neuro ICU,” Gloria called back.

Lynn reached out and grabbed onto the edge of the desk to help support herself. The neuro ICU! What the hell did that mean? As she turned and fled from the PACU, she tried not to think. The problem was that she had a pretty good idea of what it meant for Carl to be in the neuro ICU.