Tuesday, July 2, 7:15 p.m.
Mitt pushed through the swinging doors leading into the staff cafeteria and immediately began searching for Andrea. He’d phoned her the moment he got into the surgical lounge to change out of his scrubs following Bianca Perez’s colectomy. Since he’d hardly had time to talk to her for some thirty-six hours, he was hoping to meet, even for fifteen or twenty minutes. Although she’d already had her dinner by the time he called, she was eager to sit and catch up with him in the cafeteria provided she wasn’t paged for some emergency.
To Mitt’s utter relief, the Perez case had gone smoothly, without so much as a hiccup, much less a death. The attending surgeon’s name was Dr. Maria Sanchez, and she was pleasant enough, with a personality somewhere between Dr. Washington’s narcissism and Dr. Harington’s conviviality. Technically Mitt thought she was superb. Since it was his first laparoscopic case, he didn’t have much to compare it to, but as he watched the procedure on the TV monitor, he could tell Dr. Sanchez was adept at using the instruments. She worked quickly with no hesitation, and Dr. Rodriguez seemed to be able to anticipate her moves. The case had required five small skin incisions with only one being approximately three inches long and the rest much smaller, a far cry from the normal approximately eight-inch incision needed for an “open” colectomy. From skin to skin, the procedure had taken less than three hours, and with such small incisions, the patient’s recovery time would be much faster.
At the end of the case, Mitt had written the postoperative orders in the recovery room under Dr. Rodriguez’s supervision, and then, in the surgical lounge, he’d done the dictation with similar assistance. All in all, it had been a positive experience, although as Andrea had said earlier, he needed to spend some time in the surgical simulation lab to gain hands-on experience using laparoscopic tools. Obviously, it was the way of the future, especially when combined with robotic surgery.
Since it was already after 7:00 p.m. and there were not that many people in the cafeteria, Mitt was able to locate Andrea easily—especially as she was waving in his direction. After heading over to her table, he went through the expected cheek-to-cheek routine before questioning: “How are you doing timewise?”
“I’m okay,” Andrea said. “No calls yet.” She sat back down at the table. In front of her was a cup of coffee she was nursing.
“Same with me at this time last night,” Mitt said. “It seems at this hour there are lots of attendings making rounds as well as residents, so we lowlifes are spared until they all leave.”
“I was told something similar by Dr. Van Dyke.”
“Let me grab some chow, and I’ll be right back. You okay with that?”
“Absolutely. I’m looking forward to comparing notes.”
Mitt nodded, then beat it back to the beginning of the cafeteria line, taking a tray and quickly selecting some food. Surprisingly enough, he wasn’t all that hungry, but he knew he needed to eat and didn’t want to wait until he got back to his apartment because he still had three admission workups to do. When he got to the drink selection area, he slowed down and was particularly careful with the cup. He couldn’t help but remember what had happened the night before.
“That doesn’t look like enough food for a growing boy,” Andrea commented when Mitt placed his tray on the table across from her and sat down.
“It’s enough,” Mitt said. “I need sleep more than I need food.”
“So, your first night on call was a problem.”
“With the burst abdominal aorta, it couldn’t have been worse.”
“I can’t imagine what that was like,” Andrea said with an expression of extreme distaste. “But that disaster aside, how would you rate your night on call from one to ten, ten being unbearable?”
Mitt chewed for a minute, thinking. For a fleeting moment, he thought about bringing up his freaky hallucinations to get Andrea’s take, but then he quickly nixed the idea. He was afraid of her response, in the same way he was reluctant to even think much about it himself. It was, in many ways, too weird.
Clearing his throat, he said: “Ignoring the bloodbath episode, I suppose I’d rate the night a five. I was busy from somewhere around eleven until about one thirty, but it was all minor stuff like dosage questions and checking people out who allegedly had fallen out of bed.”
“Well, I’m hoping to get a little sleep,” Andrea said. “With all the excitement, I didn’t even sleep that well last night in my own bed. But moving on, I heard your first two surgeries today were as disastrous as the burst aneurysm. I can’t believe your luck, or lack of it. My God!”
“Tell me about it,” Mitt responded, briefly looking heavenward before going back to eating. “Two operative deaths, one at the end of a case with a heart that would not restart after a mitral valve replacement and a second one where the heart decided to give up the ghost before the surgery had even begun.”
“So I heard. Unbelievably bad luck. I have to say, everybody’s bummed out about it. No one can remember anything similar, not only on the same day but in the same operating room. I’m sorry you had to witness it all.”
“Thank you,” Mitt said. He was tempted to bring up his thoughts about being somehow responsible but quickly changed his mind. Now that he was out of the OR and a bit of time had passed, the idea sounded preposterous even to him. Instead, he added simply, “It’s enough to make me paranoid.”
“I can imagine,” Andrea agreed. “It also makes me hesitate to ask how your final case went today. Don’t tell me if it went badly!” She laughed humorlessly.
“Well, I’m happy to report my last case went fine. No problem whatsoever, and since it was laparoscopic, I was able to appreciate what you said about needing to spend time in the simulation lab. As for the patient, she’s already left the PACU and is back in her room.
“But enough about me and my troubles,” Mitt continued. “How was your day?”
“I can’t complain,” Andrea said. “My three cases went smoothly. I even got to sew up the skin on the last two, which isn’t saying much, but we have to start someplace. Dr. Kevin Singleton, the fourth-year resident I’ve seemingly been assigned to, is a great teacher, and I’ve also been equally impressed with the attending surgeons I’ve dealt with. How about you?”
“I’ve been similarly impressed by Dr. Rodriguez, who I guess I’ve been assigned to. As far as the attending surgeons are concerned, I have mixed feelings. Dr. Washington, the vascular surgeon on my first case, seems a shade narcissistic; whereas Dr. Harington, the cardiothoracic surgeon who did the mitral value replacement today, is a bit flaky. Maybe that’s too strong. Let’s change that to eccentric.”
“That’s an interesting distinction. What led you to that impression about Pamela Harington? I’d heard from Dr. Singleton when this morning’s death was discussed that she’s one of the more popular and respected attending surgeons, particularly with the house staff.”
“That’s why I amended ‘flaky’ to ‘eccentric.’ She’s very likable and technically she seemed great, no question. But she’s an ardent Bellevue Hospital history buff, so much so that this morning when there was a delay in getting the heart-lung machine ready to go with the patient’s chest open and the heart exposed, she carried on the entire time about Bellevue Hospital history. To my surprise, she even knew specific anecdotes about my relatives, details that I was totally unaware of.”
“She sounds like my kind of surgeon, with a healthy background in liberal arts.”
“I suppose that’s one way to look at it. It just seemed odd to me under the circumstances. But, as I said, she is very likable, although what she said about my ancestors wasn’t all that positive.”
“What on earth do you mean?” Andrea was clearly taken aback. “Do you think she was intentionally trying to make you feel uncomfortable?”
“Oh, no, not at all. Quite the contrary. To be truthful, she was ultimately embarrassingly complimentary. But at the same time, she said that my medical relatives had a penchant for being on the wrong side of some important issues—anesthesia, aseptic technique, informed consent, and one even advocated the use of lobotomies.”
“Yikes,” Andrea exclaimed. “I’m sorry to hear that. Did it upset you?”
“Not really, and you don’t have to be sorry. I assure you I didn’t take it personally. I found it more surprising than anything, provided it is true, because my family has always been so unquestionably proud of our Bellevue heritage. It’s even part of the reason I decided to go to medical school. Anyway, I’m definitely motivated to find out just how true her stories are.”
“Well, I’ll be interested to hear what you learn.”
“I’ll be sure to let you know,” Mitt said. “And about Dr. Harington: One more thing caught my attention, and that was how nonchalantly she dealt with the situation when the patient’s heart refused to restart. I mean, she had pulled out all the stops, I guess. But then when it was obvious it wasn’t going to happen she essentially just threw up her hands and said, ‘Okay, that’s it. Leave everything as is,’ and then she walked out.”
“What did you expect her to do?”
“I don’t know, to be truthful. But somehow more than what she did.”
Just then Andrea’s phone went off. She quickly answered. Mitt watched as she listened for a moment, nodded, and said: “Okay, I’ll be right there. Thank you.” After disconnecting she glanced at Mitt. “Well, the evening is starting. Someone’s fallen out of bed on Fifteen East.” She laughed.
Mitt laughed with her at the absurdity. “Welcome to the club. If you’ll wait for me to clear my dishes, I’ll come along with you. All of my admissions today are on fifteen as well.”
“Of course I’ll wait,” Andrea said as she put her empty coffee cup on Mitt’s tray before he hoisted it up and set off. At the exit, she held up, watching him slide his tray in at the soiled-dishes window. A moment later he caught up with her.
“I feel sorry for you,” Andrea said as they headed for the elevators. “It’s nearly eight o’clock on your night off, and you still have three workups to do.”
“No rest for the weary,” Mitt said, and meant it. Doing three more histories and physicals was the last thing he wanted to do. But it could have been worse. At least he’d already learned to slim down the process considerably and essentially just make sure there weren’t any contraindications for them having their surgery. Prior to Madison Baker’s advice, he would have spent an hour on each at a minimum.
They rode up in a packed elevator full of visitors and didn’t try to converse, remembering Dr. Van Dyke’s very specific warning to avoid talking in the elevators in front of nonmedical people because it invariably ended up being about patients. Once out on floor fifteen, they waited for the visitors who’d gotten off with them to disperse. At Andrea’s insistence before they parted, they went through yet another cheek-touching-air-kissing routine.
“Bonne chance,” Mitt said with an exaggerated French accent, playfully mocking Andrea’s insistence on the display of affection. “I hope you get more sleep than I did.”
“I hope so, too,” Andrea said as she set off with a wave over her head, heading east while Mitt turned to the west.
Entering the very busy nurses’ station on 15 West, Mitt felt lucky to be able to snare the last available monitor. As efficiently as possible, he read through the extensive electronic health records of his three admissions. There was Elena Aguilar, a forty-six-year-old recent emigrant from Venezuela. Mitt immediately called the translation department and was assured someone would be available in fifteen to twenty minutes. Elena was scheduled for a vein stripping. Mitt had read that the reason it had been decided to do the procedure as an inpatient rather than as an outpatient, which was typical, was because the woman weighed more than three hundred and seventy pounds.
The next patient, Latonya Walker, was a thirty-eight-year-old Black woman in for a breast biopsy and possible mastectomy. Unfortunately, she, too, was overweight, although not as dramatically as Elena. During medical school Mitt had learned that doing physical exams on such patients took longer than on thinner people for a variety of reasons.
The last patient was Diego Ortiz, age forty-four, in for a thyroidectomy for papillary thyroid cancer. He, too, was a recent emigrant, this time from El Salvador. Of mild interest to Mitt was that Mr. Ortiz’s rather small cancer had been found because a previous diagnosis of hypothyroidism required rather robust daily thyroxine treatment by mouth, drawing attention to the thyroid gland. Mitt found this interesting because he remembered from his internal medicine rotation during third year that being hyper or hypo didn’t increase the cancer risk. In Mr. Ortiz’s case, it was just that his being hypo had made his doctor examine his thyroid particularly closely, finding the small lump that was then diagnosed with a needle biopsy.
“Excuse me,” a voice said, interrupting Mitt’s thoughts. He looked up into the questioning face of one of the many nurses. “Are you Dr. Fuller?”
“I am,” Mitt said, momentarily surprised to be recognized and fearful he was about to be asked a question that he wouldn’t be able to answer.
“The translator is here,” the nurse said, pointing to a middle-aged woman in a short white coat similar to those the residents wore. She was standing outside of the nurses’ station counter.
“Great, thanks,” Mitt said with relief that a Spanish translator was available so quickly. He turned off the monitor he’d been using, gathered together his loose notes as well as the combination ophthalmoscope and otoscope he’d borrowed, and headed out of the nurses’ station.
Doing the physicals and briefs, what he now called “confirmation histories,” did take longer than Mitt had hoped. Once again, the translator was an indispensable help and thankfully very patient, but having to use her significantly lengthened the process. By the time Mitt had finished the three admissions and had returned to the nurses’ station to type up all his findings, it was well after 9:00 p.m. But at least there was one benefit to the late hour. At that time, it was far less busy in the nurses’ station, meaning there were plenty of monitors available. Earlier he’d been lucky. Now he had his choice.
As quickly as he could, he typed in all the information he’d gathered from interviewing and examining the three patients, emphasizing what he knew was the most significant, namely that all three had no signs or symptoms suggesting their scheduled surgeries needed to be postponed. He made it a point to emphasize for the anesthetist’s benefit that Mr. Ortiz was taking a sizable daily dose of thyroid hormone.
When he was finally completely done with the third case, he hit the Enter button and then rapidly stood with the intention of leaving. Instead, he had to wait for an intense but thankfully brief dizzy spell to subside. The moment it cleared, he noticed by coincidence that there was only one person besides himself in the nurses’ station, whom he assumed was the head nurse. Since he’d not yet met her, he was briefly tempted to make the effort to introduce himself, but then he changed his mind. Once again, he’d simply run out of gas. Although his dizziness had passed, its presence suggested to him that he desperately needed sleep.
After tossing his no-longer-needed notes into a wastebasket, he headed out of the nurses’ station on slightly wobbly legs, turning right to head down the long, now-empty corridor toward the elevators. But then he suddenly halted in bewildered awe. Ahead of him in the middle of the fully illuminated hallway was the selfsame hallucination he’d seen after the burst aorta incident. And at the instant he’d caught sight of the blond girl, he was also once again assaulted by the horrid cacosmia, making him gasp for air. It was as if the hallucination of the girl and the noxious smell were connected.
By pure reflex, his hand shot to his face to use his thumb and forefinger to pinch shut his nose to keep from retching. Otherwise, he remained frozen in time and space, afraid that if he moved, the apparition would again flee like it had done in the wee hours that morning. For some reason that he couldn’t explain, he wasn’t as afraid as he probably should have been, just mystified and confused. Why was his mind conjuring up such a strange vision and disgusting odor? Was his brain punishing him for denying it the rest it so sorely needed?
As the seconds ticked by, he became aware that the phantosmia had vanished but the visual hallucination hadn’t. Slowly he let his hand fall to his side as he watched the girl closely, appreciating that her expression was one of scorn, her upper lip pulled back in seeming contempt. Otherwise, she appeared the same as she had earlier, just as pale and porcelainlike, although her blond hair was even blonder in full light than it had been in the darkness, and it was now even more apparent that her dress was dated, as if she’d just stepped out of an old movie.
“Who are you?” Mitt called out, but there was no answer from the apparition, nor did he really expect one. Building up his courage to face his own imagination head-on, Mitt tentatively started inching ahead, fully expecting the hallucination would flee as it had on the first occasion, but it didn’t. Instead, the girl’s sneer turned into a self-satisfied smile, as if daring Mitt to come closer and pleased that he was doing so.
When Mitt was no more than ten feet away, he stopped because he noticed something strange. He could see what appeared to be a gleaming, narrow, slender stainless-steel rod complete with a stainless-steel handle sticking out of the child’s left eye socket and angled downward around forty-five degrees from the vertical. Now he remembered glimpsing it earlier that morning. He had no idea what it was or what held it in place, as it seemed to be defying gravity. Also, as close as he was to her now, he could make out what looked like a series of bloodstains running down the front of her bodice. Maintaining her smug expression, she reached up and pulled the stainless-steel rod from where it had been embedded above her eye and pointed it at Mitt as if threatening him with it. To Mitt it looked like a metal ice pick with a slightly flared but narrow tip.
Then suddenly the girl again bolted. But she didn’t turn and run back up the corridor like Mitt expected. Instead, she ran sideways toward a nearby door that she was somehow able to open although he didn’t see her reach for the door handle.
Mitt didn’t think about how to react to this sudden development, he just did. He ran forward, banged open the door through which the girl had just disappeared, and rushed headlong into the darkness. After just a few steps he stopped, searching vainly in the darkness of what was a fairly large room filled with indistinct shapes. The only light was what little spilled in from the hallway behind him. The door he’d thrown open had now mostly closed. The girl was nowhere to be seen. Instead, there was a sudden high-pitched screeching noise and out of the dark a student chair came right at Mitt, seemingly on its own accord.
Reacting by reflex, he put out both hands, caught the chair as it came skidding across the floor, and stopped it. Twisting around and retreating a few steps to reach the wall switch, he turned on the lights, flooding the room with fluorescent glare. Instantly, Mitt recognized where he was. He was in the surgical conference room where he’d started his residency about thirty-six hours previously. Immediately he questioned whether the location was symbolic or ironic. He had no idea, but he felt it had to be one or the other because the young girl was gone. Had the chair run into him or had he run into it? All of a sudden he wasn’t entirely certain. It had all happened so quickly.
Mitt collapsed into the chair that had come at him in the darkness or that he’d stumbled into, bent over, and, with his elbows balanced on his knees, cradled his head. He couldn’t believe himself and the flights of fancy he was capable of in his exhaustion. After rubbing his eyes and then glancing around the room one more time to make absolutely certain he was alone, he got up, turned off the light, and walked back out into the hallway. As he did so, an orderly pushing a food truck, presumably bringing some late meals to new medical admissions, passed by. For a moment, as he watched the orderly push the wagon down the hall, Mitt luxuriated in the banality of the activity, a sharp and reassuring contrast to his own madness.
Turning around, he walked to the elevator lobby, where he pressed the Down button. He needed to get the hell out of the hospital and get home, and more than anything needed to get into bed. If he didn’t manage to get some serious sleep, he feared he might totally lose his grasp on reality, especially with his newly gained respect for his own imagination.