Tuesday, July 2, 3:03 a.m.
Mitt’s eyes scanned down to the next line on the death certificate form and paused. Up until that moment he’d been doing reasonably well as he filled in the various blanks with relative ease despite his pulse still pounding in his temples and his hand visibly shaking. The pounding had begun the second Benito Suárez’s aorta, or its connection to the graft, had burst—although as he relived the event, he recognized that his general anxiety had skyrocketed the moment he’d entered the man’s room. Somehow he had anticipated the catastrophe.
Mitt’s sense of utter panic hadn’t eased up for at least a half hour after the event, not until after Madison Baker had called a halt to any resuscitation attempts. All in all, the experience had been the worst twenty or thirty minutes of his life. It had started innocently enough with confusion in trying to help the man with his pain, but then rapidly descended into sheer terror. Being literally up to his elbows in blood during his first night on call was way beyond anything he could have imagined and his worst fears.
Mitt was sitting on one of the wheeled chairs at the central desk. In contrast to the relatively dark corridors illuminated with dim baseboard lighting, the central desk was ablaze with a distinctly white light coming from ceiling-mounted LED fixtures behind translucent panels. Although the light afforded great illumination, Mitt thought it made everyone appear washed out, and as tired as he was, he couldn’t imagine how bad he looked.
“Excuse me!” Mitt called to Helena, who was using one of the nearby monitors to file her own report on the episode, which he could tell had disturbed even the nurses. He was interrupting Helena because he was stumped as to how to fill out the next blank on the form. It asked for the time of death, and he had no idea what to put down. In the thick of the ghastly event, noting the time had been the last thing on his mind.
“The patient died when you say he died,” Helena said without looking up.
Mitt started. It was hardly the answer he expected. Besides, he was already feeling guilty that he hadn’t called for help sooner. He hadn’t even been the one who called Madison. On top of that was his continuing uncomfortable feeling of unpreparedness, despite having spent four stressful years in medical school. He was officially a doctor, having received his MD degree at graduation, but he didn’t feel like one, especially as alone as he felt in a hospital with a thousand inpatients.
All these thoughts tumbling around in his mind brought back the incident with shocking clarity, and suddenly he remembered something that the stress of the situation had erased: the flickering light and then the popping noises of the skin sutures opening. As he sat there and thought about it, he distinctly remembered gawking at the sutures. It had seemed they were untying in front of his eyes, and he’d worried that he had mistakenly tied granny knots instead of square knots. It was only then that he’d noticed the abdomen was swelling. But now, sitting there at the nurses’ station, he had no idea what had come first, the swelling of the abdomen, which caused the sutures to pull open, or the popping open of the sutures, allowing the abdomen to swell.
“Just put down two thirty a.m.,” Helena called out, seeing Mitt had stopped filling in the required paperwork. “The exact time doesn’t matter. It’s merely when the patient was pronounced dead. You get what I’m saying?”
Waking from his momentary trance, Mitt nodded toward Helena and proceeded to write 2:30 a.m. in the appropriate blank. Yet he was still pondering the suture-timing issue. He wanted to take a look to see if the sutures themselves might tell him anything. Glancing back at Helena, he asked: “Do you think the body is still in the room?”
“Yes, most likely. There’s always a delay for the medical examiner to send over one of their investigators, unless the body is released during the initial phone call. Their office is practically right next door, so I expect someone will be coming by. They usually do when it involves a death this close to the surgery. And they will probably need to talk with you, so don’t rush off.”
Mitt nodded. He wasn’t planning on rushing off, since he had the rest of the death papers to fill out. But at the moment, he was captivated by the dilemma of what came first: the chicken or the egg. Seeing the first skin-closure sutures he’d ever done mysteriously untie didn’t bode well for his surgical career.
Pushing his chair back, he stood up. But then he thought of something else. “Sorry to bother you yet again, but before all hell broke loose, did you notice the lights in the room seemed to flicker or was it my imagination?”
“Now that you mention it, I do remember. It was just for a second or two.”
“Has that ever happened before?”
“I’d have to say yes. It happened pretty often when they were renovating the tenth floor a few years ago. We were told they were doing a lot of electrical work.”
“Interesting,” Mitt commented. Okay, he thought. Apparently flickering lights aren’t all that uncommon. “I’ll be right back.” He put down his pen on top of the papers he was filling out and then walked out of the nurses’ station. On his way he grabbed a package of sterile gloves.
Entering Benito Suárez’s room gave him a creepy feeling, enough to make him question why he was there. But he felt motivated since the man’s skin sutures had been Mitt’s inauguration to what he hoped would be a long surgical career. The question was whether he’d tied square knots. If he could find some of the knots intact, perhaps he could tell. Anyway, he thought it was worth the effort and wouldn’t take very long. This was his first death as a resident, and he was struggling with a sense of direct responsibility.
Benito’s body was still in the same position: on his back, arms splayed out to the sides. The IV had been stopped but it was still attached to his right forearm. With the overhead lights on, he was as pale as a ghost. Someone had closed his eyes, which Mitt appreciated. The less Mitt thought of him as a person, the easier it was emotionally.
Although the blood on the floor had been mopped up, the blood on the bed had not been touched, nor that on Benito’s abdomen or in the gaping abdominal incision. It was now a darker red and no longer fluid. As he had hoped, he could see the tips of at least a few of the black silk sutures lining the sides of the open incision, poking up out of the dried blood.
After pulling on the gloves, he teased out a number of the sutures from the clotted blood. It was immediately apparent that the three topmost sutures had no knots, as if the knots that had been there had completely unraveled, suggesting to Mitt’s chagrin they must have been granny knots. But then the rest of the knots were intact, meaning the other skin sutures had broken or had been yanked out of one side of the incision. Holding the knots within inches of his face, Mitt was able to see that they were all indeed square knots, a fact that initially made him more confused. But then he recognized there was a chance that he could have mistakenly made granny knots with the first three stitches before making square knots with the rest.
Mitt shook his head in frustration. He thought he’d tied all the knots the same, but apparently that might not have been the case. What he needed to do was promise himself that he would be more careful in the future. But was that enough to answer the question about what came first, the sutures popping or the swelling? He didn’t think so. Yes, the unraveling of the top three sutures could have marginally relieved the intra-abdominal pressure and thereby put stress on the aorta graft attachments, but he didn’t think three out of more than twenty were enough to make a difference.
“So much for that idea,” Mitt murmured as he removed his gloves and deposited them in an appropriate container. As exhausted as he was, he couldn’t think any more about anything. By now his pulse had returned to a semblance of normal and his anxiety had significantly waned from sheer exhaustion. He was closing in on having been awake and busy for almost twenty-four stressful hours.
As Mitt headed for the door, an entire team of housekeeping personnel arrived to start a definitive cleaning of the room. For a moment he was blocked from exiting as they stopped in the doorway, clearly surprised that the deceased body was still present.
“Excuse me,” Mitt said as he tried to push his way through the doorway. In the process, he made fleeting but direct eye contact with a Black woman who seemed to be in charge, and despite his exhaustion, he immediately experienced some mild paresthesia on his chest along with the sense that this woman was strangely enough empathizing with him about his recent experience.
Assuming the surprising and transitory episode was merely another reflection of his mental and physical exhaustion, Mitt didn’t stop but continued pushing through the group. Once clear, he quickly made his way back to the nurses’ station.
Twenty minutes later, Mitt was finally able to complete the paperwork required following Mr. Suárez’s death. By then Helena had apparently finished what she had to do and was elsewhere, most likely taking care of her other patients. At that moment the only other person in the nurses’ station was the night-shift head nurse whom he’d not officially met. As tired as he was, he couldn’t generate the energy to formally introduce himself.
With shaky legs, he got to his feet. Not knowing what exactly he was supposed to do with the completed forms, he just left them where they were and headed down the long, dark east–west corridor for the distant elevators. The passageway was illuminated only by the dim, nighttime, baseboard lighting system.
He was moving by rote now, placing one foot in front of the other. The only thing on his mind was how wonderful it was going to feel when he finally was able to lie down. Just staying upright required a bit of concentration. But then suddenly he stopped. Ahead, at the intersection of the two equally long corridors coming from 15 North and 15 South, Mitt saw an unexpected sight that shocked him. It was a young, strikingly blond, pale, preadolescent girl who had come from the north hallway seemingly intent on heading down the south one. Apparently seeing Mitt was equally surprising for her, as she also stopped in her tracks, staring intently in his direction.
At first Mitt thought the child had to be a patient who’d snuck out of her room to wander around, something he imagined wasn’t all that uncommon although surely discouraged. But then he realized that couldn’t be the case because the person he was seeing was definitely a child, whom he guessed was around ten years old. As far as he knew, there were no pediatric patients on the fifteenth floor, and the Department of Pediatrics was way down on the eighth floor, or so he’d been told.
And, Mitt realized, the girl wasn’t wearing a typical hospital johnny, the gown all patients were required to wear except for those up on the psychiatric floors. She had on a dress, and even that seemed oddly anachronistic. The child was clothed in a pale off-white shirtdress with puffy sleeves and a flat, rounded collar that appeared to Mitt, who’d been an old-movie buff as a teenager, to be right out of the 1940s or 1950s.
Mitt’s next thought, the clothing notwithstanding, was that perhaps the girl had managed to wander onto one of the elevators and was now lost and needed help to find her way back down to the pediatric floor and to her room. Marshalling a surge of energy motivated by concern for the child, Mitt started forward and was about to call out to her when the horrid cacosmia reoccurred with a vengeance. The smell was as bad or worse than it had been hours earlier in the elevator lobby on the seventeenth floor. It was awful enough to make him stop short and clasp his hand to his face to pinch his nose.
But then almost as rapidly as he’d been assaulted by the terrible odor, it vanished just as it had earlier, leaving him momentarily stunned. At the same instant, the young girl—having caught sight of Mitt—seemed to shrink back in either fright or antipathy, he couldn’t tell. Since she was illuminated from below by the baseboard lighting, only her delicate chin and the tip of her nose were apparent. Both eye sockets appeared as black holes beneath her nimbus of radiant blond hair, so blond it seemed almost phosphorescent.
“Wait!” Mitt called out as he again started toward the child. She was now about twenty or thirty feet away, close enough for Mitt to see that something shining in the half-light was protruding from her left eye socket. But the girl didn’t heed Mitt’s request. Instead, she spun around and disappeared from view back up the north corridor.
Sprinting ahead, Mitt reached the intersection within seconds. Ahead was the bank of elevators, five on a side. Turning the corner, Mitt looked up the north corridor, intending to catch up to the fleeing girl. But again, he abruptly stopped. From where he was now standing, he could see all the way to the hallway’s end, where it abutted the corridor that ran along the 15 North patient rooms. Shockingly enough, the corridor was completely empty. There was no young blond patient on a midnight foray. Instead, way at the end, he glimpsed a passing nurses’ aide carrying a tray of medications to one of the nearby patient rooms.
Slowly Mitt’s jaw dropped open in amazement and concern. He released a long breath and sagged against the wall of the corridor, letting the back of his head rest against the Sheetrock. He closed his eyes. One question burst into the forefront of his mind: What the hell is happening to me? He feared he might be losing it. Could the combination of his nonstop anxiety and physical exhaustion take a serious toll on his sanity and cause hallucinations?
Mitt took a deep breath in, held it for a moment, then let it out again through pursed lips. Somehow the fluttering sound and the physical sensation it made were reassuring. For a moment he had no idea of what to think or do. Maybe he was not cut out to be a surgical resident, and the disturbing question of whether that might be true hung unanswered in the air. Did other first-year residents have similar reactions? Had Madison gone through something equivalent a year ago? He had no idea, but her current apparent confidence was encouraging. As agitated as he felt, he wanted to grab onto anything to feel reassured.
Mitt opened his eyes, looking north once again, almost hoping he’d see the blond girl, but he didn’t. Instead, he saw what looked like the same nurses’ aide again walk past, now going in the opposite direction. She’d apparently dispensed the medication she’d been carrying and was on her way back to the nurses’ station. Somehow just seeing such a normal nighttime hospital routine gave Mitt the bit of reassurance he needed to counteract his concern that he was going off the deep end. Olfactory and visual hallucinations were worrisome symptoms, yet it all had to be a combination of stress, anxiety, and exhaustion. What he needed was sleep. It was nearly 4:00 a.m. by his watch, and he’d have to wake up around 6:00 to be prepared for rounds at 6:30, as Dr. Kumar had stressed. It wasn’t going to be much rest, but he had to think that was better than none at all.