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“What am I seeing?” Lynn asked in a hesitant voice. It was all she could do to keep from recoiling and running from the room.

“Notice that when I rotate the head, the eyes move in the opposite direction.” Charles rotated Carl’s head again.

It was now easy for Lynn to see that Carl’s eyes did rotate as Charles had described, blankly staring upward as his head went to the side.

“It’s a vestibulo-ocular reflex,” Charles said in a didactic-medical monotone that was all too familiar to Lynn. “It means that the brain stem and the involved cranial nerves are operating as they should. If the patient is malingering, acting as if unconscious, something you will see on occasion in the ER, the eyes move in the direction of the rotation. If the brain stem is not functioning, then the eyes don’t move at all. Rather dramatic, wouldn’t you say? I could also show you the same phenomena using caloric stimulation, meaning putting cold water into his ears. Would you like to see that as well?”

“This is quite enough,” Lynn said. She pulled her hand back, allowing Carl’s eyelids to close slowly. She had to get away. To where, she didn’t know. As a member of the hospital community and soon to be a doctor, she felt a responsibility in Carl’s disaster above and beyond her recommending Dr. Weaver and the Mason-Dixon Medical Center.

“I have all the paraphernalia available,” Charles said. “It will only take a second to get it. It’s no imposition whatsoever.”

“Thank you,” Lynn said, backing up from the bed. “I appreciate your taking the time to show me what you have, but I have to go. I’m sorry.”

“That’s quite all right,” Charles said. He stared at Lynn and furrowed his brows. It was obvious he was confused about her behavior. “If any of the other members of your preceptor group would care to see this classic doll’s eye movement, I’d be happy to show it to them.”

“Thank you,” Lynn said. “I’ll let the others know.”

Lynn fled out of the ICU. Once in the hall, she stopped and took a few deep breaths. It was somehow comforting to be back in
the usual commotion of the hospital with patients, nurses, and orderlies passing her. Her heart was still racing. There was nothing she could do to help Carl, and her first thought was that she had to find Michael. She needed an anchor, someone to hold on to during this storm of uncertainty and emotion.

Monday, April 6, 12:25
P.M.

L
ynn found Michael in the cafeteria. She had first gone back to check the coffee shop, but he and the others had left. She thought about texting him but had no idea what to say. Instead she wanted just to find him. Maybe she wouldn’t even say anything for a time.

Considering the hour, she had decided the cafeteria was the best bet, as the food was considerably cheaper there than at the coffee shop, and Michael rarely missed a meal. As usual the room was crowded with its usual lunchtime rush. It had taken her a moment but she managed to locate him in the food line. She felt lucky he was by himself. The other members of the earlier coffee-shop group were nowhere to be seen. She was glad about that. She wanted to talk only to Michael.

“Hey, Lynn. How’s Carl doing?” he asked when he turned to look who had tapped him on his shoulder.

“I need to talk,” Lynn said, her voice faltering. “Privately.”

“Okay, no problem,” Michael said. Knowing her as well as he
did, he immediately sensed her brittle emotional state. He eyed her. “You okay?”

“That remains to be seen,” Lynn said. There was an audible catch in her voice.

“How about grabbing some lunch and hanging with me?”

“I’m not hungry at the moment.”

“Do you mind if I eat while we talk?”

“Of course not!”

“Then let me settle up for these vittles. Then we can sit over there in left field by the far wall. I see a couple of free tables.”

Lynn glanced in the direction and nodded. The cafeteria was as good as anyplace else in the hospital for a talk with Michael. The hubbub might actually help her keep her emotions in check.

Although Lynn wasn’t hungry, she was thirsty, and she got herself some water before sitting at one of the free tables they had seen from the steam-table line. The area was farthest away from the windows, which looked out onto a sumptuously landscaped interior garden. A number of tables in the garden were the most popular, and were the first to fill up when the weather was as good as it was. Lynn could see quite a few of her classmates outside.

As she sat waiting for Michael to pay, she watched him in the checkout line. He was a commanding presence and stood out from the similarly white-coated medical students. The main reason was a combination of his size and the fact that he was black. In Lynn’s class there were only three African American males along with five females of color, making up only 6 percent of the class despite the school’s active recruitment efforts. Michael was a muscular man with a thick neck who Lynn learned had played football at the University of Florida and who had had a shot at playing professionally had he not set his heart on becoming a doctor. Lynn knew that the career choice was a debt he owed to his mother. His features were broad, his skin a dark mahogany, and his hair was relatively long and worn in what Lynn had come to know was a lock-twist.
Initially she thought they were short dreadlocks but now she was the wiser.

Back on the second day of medical school when Lynn had first spoken with Michael when paired with him for the anatomy lab, she had been mildly intimidated. Not only was he a sizable man, but he seemed to her to have an animus toward her right out of the gate. From their first words he complained about her attitude, so she did the same. During the initial days they merely tolerated each other, and both had to make an effort just to get along well enough to work together.

Lynn had never considered herself racist, but over time Michael had made her see that she had been to an extent, and that racism was unfortunately alive and well in America. Michael for his part learned from her that he was so accustomed to having to deal with patronizing attitudes that he often evoked it. He also came to learn from her that despite fifty-plus years of feminism, misogyny and gender discrimination had not disappeared. Both came to understand that with racism and gender issues, one had to be a member of the oppressed to really appreciate the subtleties and the not-so-subtleties of discrimination that had so influenced their respective lives. Throughout her life, Lynn always felt she had to do a bit better than the men with whom she was competing whereas Michael always felt he had to do much better than everybody.

As Lynn and Michael came to understand they were kindred spirits, they began to appreciate each other’s idiosyncrasies apart from race and gender, stemming from their different backgrounds: Lynn, from a middle-class Atlanta upbringing, with two siblings who ultimately fell on hard times; and Michael, from a single-parent household from the South Carolina Low Country, with five siblings who had had to struggle to keep a roof over their heads and food on the table. They also became aware of their similarities besides their being extremely motivated hard workers who strived for excellence. Both had defied stereotypes and had responded to
STEM programs in their schooling, meaning science, technology, engineering, and math. Both early on liked computer gaming and had an interest and facility in coding. Both had aced college. In medical school both were on full scholarships, which was the main reason they were at Mason-Dixon University. Both of them had been accepted at all the medical schools to which they had applied, but Mason-Dixon had had the best offer financially. Finally, although Lynn had been close to her father, she also knew what it was like not to have one.

As Michael approached, Lynn felt thankful for their relationship and grateful to the school for having paired them up. She had never had a male friend like Michael, and valued their relationship, as he had truly expanded her life in so many ways. And now, if the neurology resident was right in his prognosis of Carl’s condition, she was going to need Michael’s support more than ever.

“Okay, whassup?” Michael said, affecting nonchalance while sliding his tray onto the table. He settled his solid two-hundred-pound frame onto the chair, which squeaked in protest. He picked up his sandwich and took a healthy bite.

For a minute Lynn was unable to speak. She wasn’t one to cry often, possibly because of a reaction to the stereotype, and she didn’t want to cry now. She felt torn. She wanted Michael’s support to avoid the sense of isolation that she was already feeling from the shock of this unfolding calamity, yet she worried that telling Michael about what had happened would make it more real. As a medical student, she knew enough about the psychology of the grief reaction to know that she was still solidly in the early denial stage.

Michael did not press her. He chewed his sandwich and took another bite, seemingly ignoring her. He was content to wait. He knew her well enough to be concerned. Something significant was in the wind, and it had to do with Carl and his surgery.

Lynn took a drink of water and then closed her eyes tightly. When she opened them she let the facts flow out, explaining about
Carl’s apparent anesthesia disaster and how she had gone up to the neuro ICU and talked with the neurology resident. She concluded by saying that Carl’s Glasgow score was only five and that the neurology resident said the prognosis was dismal.

Michael put his sandwich down and pushed his plate away as if he had lost his appetite. “That’s a low Glasgow score.”

Lynn stared at her friend. There were lots of times that he amazed her, and this was an example. She had never heard of a Glasgow score, and Michael apparently had, despite the fact that they both had taken the same neurology rotation during their third year. He had a facility to remember facts no matter how obscure. “How do you know about the Glasgow score? I don’t think I have ever heard of it.”

“Let’s just say I had reason. It is a way to evaluate people in a coma. What was the neurology resident’s name?”

“Charles Stuart, I think. I don’t know for sure. My mind isn’t working at full speed.”

“I don’t think we had him for any part of our neurology rotation.”

“I know for sure we didn’t. I had never seen him before.”

“What else did he say besides the Glasgow score and that the prognosis was not good?”

“He said that he expected to see extensive laminar necrosis on the MRI when they do it.”

“I don’t know what laminar necrosis is.”

“I don’t, either, but it is not hard to guess.”

Michael nodded. “Did you talk to anyone else, like the surgeon or the anesthesiologist?”

“I haven’t spoken to anyone. I wanted to talk to you first.”

“Did you look at the anesthesia record?”

“No. All I did was see if it was Carl, and it is. He’s in a freaking coma, for Chrissake! And I was the one who recommended the
doctor and encouraged him to get his fucking knee fixed here at Mason-Dixon.”

Michael reached out and enveloped Lynn’s comparatively narrow wrist with his large hand. His grip was firm. “Listen, sister,” he began. When they were alone together they jokingly called each other sister and bro, a bit of Black argot that Michael had instigated as a sign of their platonic intimacy and comfort with each other. As a further sign of their closeness, he also treated her to basketball metaphors he’d used with his buddies in high school. “I can tell you right off the top, you are not responsible for whatever happened during today’s game. You weren’t a player. No fucking way!”

Despite her efforts at control, tears brimmed and some spilled over Lynn’s cheeks. She wiped away the moisture with a knuckle of her first finger. “I know I’m going to feel a certain amount of guilt no matter what; I know myself well enough. But what about his parents? They had wanted him to have his surgery over at Roper Hospital. Why did I interfere?”

Carl’s father was a lawyer in Charleston like his son but at a different firm and involved in a different specialty. The father’s area of interest was litigation and criminal law, unlike Carl’s emphasis on real estate and corporate law. His mother was an elementary school teacher. The parents lived in the same house in West Ashley where Carl had grown up. Lynn had met them on numerous occasions, particularly over the last several years, as Lynn and Carl’s relationship had solidified. Even Michael had met them for a couple of celebratory birthday dinners.

“The Vandermeers are smart people,” Michael said. “And it’s easy to see they care for you. They are not going to blame you. No way!”

“I’m not sure I wouldn’t if I were them.”

“But we’re jumping the gun here. We don’t really know as an absolute certainty what’s going on. Here’s my take: Let’s hightail it up to the neuro ICU before our dermatology lecture and check out
Carl’s chart.” Mason-Dixon Medical Center had a fully integrated EMR, but there were still physical charts for inpatients while they were in the hospital. There had been some talk of completely phasing out the charts, but it hadn’t happened, at least not yet.

“What will that accomplish?” Lynn wasn’t sure she could go back quite so soon. Seeing Carl in a comatose state was enormously unsettling, to say the very least.

“I don’t know, but we will have a better idea of what happened. There has to be an anesthesia record in the chart. I mean, there must be some explanation. Come on!” Michael started to get to his feet.

Lynn grabbed Michael by the sleeve of his white coat. “They are not going to look kindly on two medical students appearing without authorization to look at a chart in the ICU.”

“Leave it to me,” Michael said. “As I’ve told you in the past, most people think I’m either a token or a Tom. Sometimes it causes problems, but sometimes it helps. This is one of the times it will help. Trust me! Besides, I’ve done it before.”

“In the neuro ICU?”

“Yes.”

“When?”

“About three months ago.”

“Why?”

“We’ll talk about that later. Let’s go up there and see Carl and hope to hell Doc Stuart is wrong.” Michael got to his feet and tugged on Lynn’s arm to get her to stand. To Michael she looked like a deer caught in headlights. He picked up his tray and carried it over to the window. Lynn followed. She appreciated that someone else was making the decisions.