Host (9 page)

Monday, April 6, 1:16
P.M.

L
ynn changed out of her scrubs and put on street clothes, anger bubbling up inside her. She was furious at the anesthesiologist, at the hospital, at medicine in general, and was reminded of how she had felt after her father died. She wanted to kick the locker where her clothes had been. She wanted to break something as she combed her hair with quick, angry strokes.

The trouble was in some respects that she knew too much. If she weren’t a medical student she could have hoped he would just wake up and be fine, which was what the Vandermeers were apparently assuming. Lynn wished she could indulge in such optimism, but she couldn’t. She knew that wasn’t going to happen. The neurology resident expected the MRI to show in detail extensive laminar necrosis of the cortex, whatever the hell that was. Yet she was knowledgeable enough to know that it meant the death of a lot of cells in the part of the brain that made people human.

Translated, it meant that even if Carl were to wake up, he wasn’t going to be the same Carl. There wasn’t going to be a happy ending, no matter what. It was a lose-lose situation. For a brief second she
thought that it would have been better had he died, but then she quickly amended the thought, embarrassed at its selfishness. At least now there was a glimmer of hope, no matter how unlikely. He was, after all, still alive. Maybe there could be a miracle.

Pulling on her white coat, Lynn looked back at her image in the mirror. Her lips, normally full, were compressed in a grim line. Her green eyes stared back with hostile intensity. She was now clearly in the anger stage of her grief reaction, having already abandoned the first stage of denial. She couldn’t help but feel that the American medical system had failed her again. The first time had been in relation to her father, Ned, who had been unlucky enough to have had a rare genetic blood disease called by the acronym PNH. It was one of the so-called orphan diseases that affected fewer than ten thousand patients worldwide. After almost four years of medical school, Lynn knew a lot more about the disease than she did when she was in college. She understood now how the disease destroyed red blood cells during the night. She also knew she didn’t have it and wasn’t a carrier.

In 2008, when Lynn was a sophomore at college and the recession hit, Ned had lost his job and, with it, his health insurance. The health insurance had been paying the extraordinarily high cost of the medication that was keeping him alive. Although Ned had been able to pay the premiums himself for a year, the insurance company voided the policy as soon as they could, as it was before the Affordable Care Act. That meant no lifesaving drug, which ultimately meant Ned’s death. At the time Lynn didn’t know all of these details, just that the family was in difficult economic straits. When she did learn what had happened, it helped solidify her desire to go into medicine to try to change the system, especially after learning that the exorbitantly priced drug was so much cheaper in Europe and even in Canada. Now she felt the US health-care system had come back to bite her again.

To pull herself together, Lynn splashed cold water on her face.
Behind her she saw the tall figure of Dr. Scott come into the changing room and go to her locker. For a moment Lynn debated whether she should go over to talk with her and ask if she would help look into what had happened to Carl, but Lynn rapidly changed her mind. It was too soon. She recognized she didn’t know enough even to ask intelligent questions, like how often something like Carl’s case occurred around the country. At the moment all she knew was that it had happened twice at Mason-Dixon Medical Center, only a few months apart.

Instead of talking to the surgeon, Lynn concentrated on leaving before Dr. Scott happened to see her. She didn’t want to talk to her or anyone. She knew she was on thin ice emotionally, especially now that her anger was trumping her denial.

Lynn used the stairs to avoid running into anyone she knew in the elevator. Once on the ground level, she ducked through the clinic building, which provided a shortcut to the dorm. She made it a point to steer well clear of the clinical amphitheater, where the ophthalmology lecture was being held.

Emerging from the hospital confines into the glorious Charleston mid-spring sunshine, Lynn felt a modicum of relief just to be outside. With the birds singing and the warm sunshine knifing down through the flowering trees in the landscaped quadrangle of the medical center, she tried not to think. But it was an effort to keep her thoughts at bay, and it didn’t last. Off to her right was the immense hulk of the Shapiro Institute, loudly reminding her of the plight of the brain dead.

In sharp contrast to all the other buildings forming the Mason-Dixon Medical Center complex, the Shapiro Institute seemed to be only two or three stories tall. It was hard to determine, since it had almost no windows, making it appear as a monstrous rectangle of polished granite. Lots of flowering trees and shrubs were planted around its perimeter in an attempt to soften its stark lines. There was only a single, solid, blank entrance door set back under a stone
arch along its facade. There had been times when Lynn and Michael were walking back from the hospital when shifts at the institute must have been changing, and they saw personnel emerge. There were never many people. Those they did see were always dressed in unique white uniforms, something akin to surgical scrubs but more stylish and form-fitting even though they were one-piece coveralls.

Stopping for a moment, Lynn stared at the building, wondering if Ashanti Davis was still there, and if she was, how she was doing. Lynn shuddered, wondering what it would be like for Carl if he were moved into the facility and whether she would be allowed to visit. She doubted she would, since she was not immediate family.

She thought back again to the single second-year official tour that she and Michael had had, along with their classmates. She clearly remembered the details of the story behind the name. It was in honor of Arnold Shapiro, a twenty-one-year-old college student from Texas, who ended up in a persistent vegetative state for fifteen years. The immediate cause of his condition was thought to have been hypoxia. His heart had stopped spontaneously and there had been a delay for an unknown period of time before he’d been resuscitated by EMTs. The case had ignited a fierce legal battle between Arnold’s divorced parents whether to maintain him indefinitely or to discontinue the feeding tube and let him die. Ironically the case became a poster for both sides of the issue. Lynn and Michael had been told that the rationale for naming the facility after Arnold Shapiro was because throughout his ordeal Arnold had received excellent care from being in the spotlight. The goal of the Shapiro Institute was to give that same level of care to anyone who needed it, whether famous or not.

Thinking of Carl possibly getting shuttered away for years made Lynn shudder again and turn away from staring at the building. Quickly she recommenced walking toward the medical school dorm. She knew she had to get a grip on herself.

The dorm room she had occupied from the first day she had
arrived at medical school was on the fourth floor. It was small but pleasant, and most important it had an en suite bathroom. The window looked out across the Cooper River with a view of the graceful Arthur J. Ravenel Jr. Bridge arching over to Mount Pleasant. The river was wide at that point and looked more like a huge lake.

There was a framed photo of Carl on top of the bureau. Carl was laughing and holding up a pina colada, complete with a pineapple wedge, a maraschino cherry, and a miniature paper umbrella. The photo had been taken that past summer on his twenty-ninth birthday at Folly Beach, a popular nearby resort. They had rented a small but charming cottage for the weekend.

Lynn reached out and turned the photo over. It was painfully reminiscent of a different time and place. After tossing her white coat over the back of her desk chair, she changed into more appropriate biking clothes and grabbed her helmet, backpack, and sunglasses. In the backpack went her cell phone, a fresh legal tablet, and a couple of pencils. Other than her bike helmet, she didn’t need anything else, since she had gradually stocked some basic clothing and toiletries at Carl’s house.

Lynn biked due south until she could veer off onto Morrison Drive, which eventually turned into East Bay Street and finally into East Battery. It was a progressively scenic route the farther south she went, especially when she reached the historic downtown district. When she got below Broad Street, where most of the historic homes were located, she passed the area called Rainbow Row, a series of early-eighteenth-century row houses that had been built on the edge of the Cooper River. They were all painted in historically accurate pastel Caribbean colors, a legacy of the English settlers from Barbados. Lynn’s mood cheered a smidgen. Charleston was a beguilingly beautiful city.

Monday, April 6, 2:05
P.M.

M
ichael slipped his pen into the pocket of his white coat. He had tried taking notes to keep focused, but it wasn’t working. The main problem was that the lecture wasn’t about clinical ophthalmology, as he had expected. Rather it was a tedious review of the anatomy of the eyeball and its connections to the brain. It was material Michael and his classmates had studied extensively during their first year.

One of the secrets to Michael’s academic success was that he could speed-read with remarkable retention. He had worked laboriously on the skill from early childhood, always careful to keep his developing proficiency a secret from his friends, particularly his male friends and particularly in high school. In the social circles he ran in, being a good student and the effort it took weren’t assets. On the contrary, they were suspect.

As far back as Michael could remember, his hardworking mother, who cleaned houses and washed other people’s clothes, had harped on the belief that education was the express train out of the ghetto poverty trap, and that speed-reading was the ticket. Michael
had taken the advice to heart, and, thanks to good genetics inherited from his mother and the father he had never really known, he had had the ability to master it. Now, with his medical residency in the bag, suffering through a two-hour marathon review of material he had already been sufficiently exposed to was a ball-buster. The reality was that he could relearn what was being presented on his own in a fraction of the time and with better recall. It was also true that his mind was wandering. He couldn’t stop thinking about Lynn, Carl, and, of all people, Ashanti Davis.

Michael glanced around at his classmates. It was obvious that just about the whole team was suffering. Those students who weren’t sleeping had glazed eyes, suggesting to him that only a handful of neurons in their brains were functioning. “Fuck this,” Michael said to himself. “I’m breaking out!”

Taking advantage of the dimming of the lights for yet another series of computer-generated images, Michael impulsively got to his feet and left. It took only a moment since he had taken an aisle seat in the rear, near the exit. Still, he knew he risked being noticed. As a black man entering into a profession where the percentages of black male physicians were low and falling, anonymity for him was rarely an option.

The clinic was in full swing. Every available chair was occupied by a patient. A number of them looked up hopefully when they glimpsed Michael and his white coat in hopes that their waiting was about to end. None of them had any idea their waiting was due to a lecture. Many of the white patients quickly averted their gaze. It was similar to the lack of eye contact with the attending physicians, the vast majority of whom were white, that had bothered Michael during his first year, when there was an introduction to patient contact. Now he took it in stride. He correctly realized it was their problem, not his.

Michael had good rapport with patients white and black once
they got over the initial hesitation his blackness occasionally engendered. In fact sometimes the white patients adjusted faster. Some blacks would assume that Michael was an “Oreo,” a black-vernacular label for someone overly assimilated, or “black on the outside and white on the inside.” But that surely wasn’t the case. Michael fully identified with his roots and the black community, and intended to serve it by bringing Harvard know-how back to Beaufort, South Carolina.

Intending to head over to his dorm room to search for Ashanti’s anesthesia record, Michael left the clinic by the same exit that Lynn had used earlier. As if further mimicking her, he stopped in the landscaped courtyard at just about the same spot that she had and gazed at the Shapiro Institute for the same exact reasons. He wondered if Ashanti Davis was still in there, being kept alive by the wizardry of modern medicine. He also worried whether Carl was destined to be transferred in there as well. He knew that would be a major stumbling block for Lynn.

Michael was well aware, at least theoretically, that a patient in a vegetative state could be kept alive almost indefinitely. He knew there had been a patient who had been kept alive for thirty-seven years. What it required was not rocket science but merely a careful balance of the body’s internal environment, meaning proper hydration and electrolyte balance, appropriate nutrition, and careful skin care. For long-term nutritional needs, the best solution was a percutaneous gastrostomy tube, placed by surgery through the abdominal wall directly into the stomach.

Of course, another major requirement was to keep all the various microorganisms at bay, such as bacteria, fungi, and viruses, since it was often the case with such patients that their immune systems weren’t up to snuff. Appropriate drugs such as antibiotics and antivirals were used when needed, but the main defense was accomplished with reverse precautions, meaning to keep the bad bugs
away from the patients. Prevention of infectious disease was the reason visits to the institute were restricted to immediate family, and even these were discouraged for the patients’ collective benefit. Immediate family had to view their stricken loved ones through a plate-glass window.

From his rotation in the ICU during third-year surgery, Michael was well aware that the biggest threats for long-term care of unconscious patients were pneumonia and the lowly bedsore. Patients had to be turned constantly to avoid being in one position for too long, because that was how infections and pneumonia were fostered. The more mobilization, the better, which was why such care was generally considered labor intensive, except in the Shapiro Institute. On Michael’s one and only visit during the second year, he had learned that the Shapiro’s secret was computerization and automation. What that really meant, he wasn’t sure, because he and his classmates didn’t get to see any real patients. The visit had been limited to a didactic lecture and a short stint in a family visitation area, where a dummy had been used for demonstration purposes.

Thinking about Ashanti Davis and her ignominious end reminded Michael of his own success at having defied the odds. Here he was, about to finish medical school and head up to a medical residency in the lofty Ivy League while most of his childhood acquaintances were either already dead or in prison, or with severely compromised futures, like Ashanti. About a week earlier, as a way to chill out after the anxiety of the residency matching program, he had hidden in his room and social-surfed himself to near brain death, looking up as many of his old friends as he could, using multiple sources. It had been a depressing pastime, and it made him really question how he had been so lucky.

Mostly Michael gave credit to his mother and the way she ragged on him about education and reading skills. But he also gave himself some credit for not falling prey to the culture in which he had found himself immersed. Things could have worked out very differently,
and he very well could have ended up a hashtag in Beaufort, South Carolina’s, homicide statistics. As a young, skinny teenager he had dealt drugs for a while, as it was an easy way to help support the family. He was also good in sports, and both activities pushed him to the head of the pack. But being at the head also meant trouble, and protecting his honor required quick response to threats. At first going to blows with fisticuffs was adequate, but by the eighth grade it meant having to pack.

For Michael, the meld of pistols and passion was what changed the game. He was judicious enough to understand that packing heat was a no-win situation, especially after his cousin had been shot dead by a supposed friend and fellow hoopster who had mistakenly become enamored with the flighty Ashanti. From that moment Michael had no more truck with drugs, would-be gangstas, guns, or hot spots. He was no longer interested in running wild. He avoided all situations that could lead to confrontation, like messing with any girls who dated gang members, or even trash-talking opponents on the b-ball court, or gloating over accomplishments of any sort.

As if waking up from the trance that his reverie had spawned, Michael found himself sprawled out on one of the many park benches that lined the quadrangle’s walkways, still transfixed by the Shapiro Institute. He was taken aback by what his thinking about Ashanti had engendered. And as he reflected some more, he found himself wondering if it had been his mother’s words or his own inclinations that had kept him from being killed or killing someone who he might have felt had somehow slighted him. He didn’t know the answers. But it all certainly raised the question in his mind of how his life might have been different had he not learned to speed-read or if he had a father, and if he had, whether it would have helped or hindered. One way or the other, Michael felt he was one lucky dude.