After recovering from the initial shock of the tone, Lynn snatched up her smartphone. With her heart thumping in her chest from being startled, she looked at the screen. What she expected to see was a text from Michael, maybe telling her she better get her ass over to the clinic. On any given day, he was the one who most often texted her. But the message wasn’t from Michael. Instead it was from Dr. Janet English, the medical school dean! With trepidation, Lynn read the text. It wasn’t long.
Miss Lynn Peirce, I want to see you in my office at 5:00 p.m., immediately after ophthalmology clinic. Respectfully yours, Dr. Janet English, Dean, Mason-Dixon School of Medicine.
Slowly Lynn put the phone back down. A feeling of dread crept over her. She leaned forward and read the text again. Her heart rate, which had begun to slow from the initial start, now speeded up again. The question was, why would the dean of the school want to see her? Her initial thought was that it might be about her missing a few ophthalmology and dermatology lectures, but then she realized it couldn’t be something so benign. The message said she should come after the ophthalmology clinic, meaning the dean thought that Lynn was there, as she was supposed to be.
Lynn had never actually met the dean of the school face-to-face, despite her having been at the school for almost four years. She had seen her only from a distance at various medical school functions, as she had on her first day, when Lynn was a freshman and Dr. English gave the welcoming address at what was touted as the “white coat” ceremony. The dean was not known to be a particularly sociable individual. It was common knowledge that she preferred her admin functions and research interests over direct student contact, which she delegated to the dean of students.
Rather quickly Lynn began to worry that Rhodes and/or Wykoff had gone ahead and checked whether she and Michael were authorized to look at Carl’s chart in the neuro ICU. If the dean had been informed, she would be livid and was now summoning them to accuse them of a major HIPAA violation. Lynn could hear Michael’s reminding her it was a class 5 felony. Would the school prosecute them? Lynn had no idea. In a way she doubted it, as it would be a first offense, but who was to know. And if they did prosecute them, would it be the end of their careers in medicine? Lynn had no idea about that, either, but recognized there was a chance. She shuddered, having a major guilt trip about involving Michael.
Thinking of him, she wondered if he had gotten a similar text. Quickly she texted him and posed the question. She knew he was most likely in the ophthalmology clinic but guessed that he could probably manage to text her back. She was right. His text popped up on her screen within minutes:
Michael: That’s affirmative. What’s the deal?
Lynn quickly texted back.
Lynn: Wish I knew. Afraid Rhodes and Wykoff might have blown our cover re/Carl’s chart.
Michael: Possible but doubt it. More likely pissed we spoke with Wykoff.
Lynn: hope ur right. I’ll meet you in clinic just before 5. We can go together.
Michael: ur on, girl !
Replacing her phone on her desk, Lynn was amazed Michael was taking this text from the dean in stride enough to use an emoticon. Under the circumstances, it seemed inappropriate and out of character. He had never used an emoticon before in any text he had sent her. Yet it did make her feel better. It certainly suggested he was relaxed about the dean’s demand that they appear in her office, and if that were the case, maybe she should be, too.
Yet even in the best-case scenario, that Dr. English wanted to meet with them merely to chastise them about talking with Wykoff, Lynn was enough of a realist to understand that afterward there was a good chance that Carl’s chart and even visiting him would be off limits. The staff in the neuro ICU might very well be forewarned, and that would be a major problem for Lynn.
Of course she wasn’t sure about anything. Was such paranoid thinking a form of denial her mind was using to avoid dealing with the reality of Carl’s coma and gloomy prognosis, and her own guilt? Was she jumping to unwarranted conclusions? Lynn didn’t know. And another thought occurred to her. Maybe she should do her investigating more on her own. She now recognized more than she had before that there might be a personal cost. If someone was going to take a fall, it should be her, and her alone, not Michael.
Lynn looked at the time. It was almost three-thirty. That meant that the neuro ICU day shift would have changed to the evening shift. There would be new people. Also there wouldn’t be a problem getting to the dean’s office by five. If she wanted to look at Carl’s chart again, which she did, now was the time to give it a try. All she could do was hope that the reason the dean wanted to see her and Michael didn’t have anything to do with their overt HIPAA violations.
27.
Tuesday, April 7, 3:40 P.M.
Forgoing the shower and change of clothes she had planned on, Lynn hustled over to the hospital. In her paranoia, she found herself worrying that the dean might have forewarned the neuro ICU staff about her activities even prior to the scheduled meeting in the dean’s office. Unfortunately there would be no way to know before walking in and giving it a try.
Deciding to continue with the anesthesia rotation ruse if she was asked what she was doing in the neuro ICU, she made another stop in the women’s surgical locker room to put on scrubs. Dressed as such, she didn’t stand out as a medical student.
Reaching the neuro ICU, she paused outside, just as she had done on previous visits, only this time it wasn’t because she feared what she was going to see vis-à-vis Carl but rather that she worried about her reception. Gathering her courage, she pushed in.
As the door closed behind her, she hesitated as her eyes quickly scanned the room. Ostensibly the ICU was the same as it had been that morning, with the same sounds and smells. As usual, the patients were for the most part stationary. The only activity in the room came from the nurses and aides going about their business. A few looked in Lynn’s direction, but no one registered any untoward response or recognition, and no one approached her. She felt encouraged and was able to relax a degree.
She glanced over to Carl’s cubicle from where she was standing. Except for his leg in the CPM, he was as immobile as he had been that morning. A nurse was adjusting his IV. Lynn considered going over to his bedside but decided against it, as it would accomplish little more than to possibly upset her, which she didn’t need. Looking over into Scarlett Morrison’s cubicle, she could see that the woman had been transferred. There was a new patient in her place, attended to by a neurology resident. Thankfully the resident wasn’t Charles Stuart, as that might have been potential trouble.
Turning her attention to the central desk, Lynn picked out the woman who was most likely Gwen Murphy’s equivalent on the evening shift. She was sitting in the charge nurse’s command seat. She didn’t look up as Lynn approached. Peter Marshall, the ward clerk, had left for the day. An attending physician was sitting with her back to Lynn, bent over a chart, dictating. Lynn did a double take. As chance would have it, it was Dr. Siri Erikson!
For a moment Lynn thought of hightailing it and returning later when the hematologist was gone. After having a mildly disturbing encounter with the woman that morning, Lynn wasn’t sure she wanted to risk another conversation. But, not knowing what was going to happen in the dean’s office in less than an hour, this might be her only opportunity. She had to take the chance.
After a reassuring breath, Lynn entered the circular desk area. She smiled pleasantly at the charge nurse, who looked up with a questioning, wrinkled brow. Lynn hoped her disguise would carry the day, as medical students were not a common sight in the neuro ICU late in the day and without a preceptor. Lynn could see her name. It was Charlotte Hinson. She was a heavyset blonde in her late thirties but with a sprinkle of freckles across her nose that made her look particularly youthful. “Can I help you?” she asked. Thankfully her tone was pleasant and not confrontational.
“I’ve come to chec
k in on Dr. Stuart’s patient, Carl Vandermeer,” Lynn said, keeping her voice low. “I wanted to see the result of the serum electrophoresis.”
“You could have checked the EMR,” Charlotte said cheerfully. “It’s in there. It was mentioned at report. It would have saved you a trip.”
“I was in the neighborhood,” Lynn said, forcing another smile. If she could have looked at the electronic record, she certainly would have. Right from the beginning of this nightmare, she knew enough not to try to access Carl’s EMR. She might have gotten to see it once, but then her doing so would have been flagged immediately, and she would have heard from the security people in the Medical Records Department. The EMR were protected more diligently than the physical charts.
To be helpful, Charlotte gave the chart rack a spin, as it was within her reach, but both she and Lynn noticed the 8 slot was empty.
“I’ve got the Vandermeer chart,” Dr. Erikson said, overhearing the conversation. She had turned to face Lynn. “Miss Peirce, nice to see you again.”
“Thank you,” Lynn said. It seemed conversation was inevitable. “Sorry to be a bother yet again.”
“No bother! Please, sit down! I enjoyed our chat this morning. We can talk about the case together. I’ve been asked to do a formal consult on Mr. Vandermeer.”
To Lynn’s surprise, the woman seemed friendly, not at all like she had been that morning. After a brief hesitation, Lynn pulled a chair over and sat down. She felt she didn’t have a lot of choice if she wanted to avoid offending the mercurial hematologist. Dr. Erikson immediately pushed Carl’s chart over. It was open to the page with the results of the serum electrophoresis, just what Lynn wanted to see.
Lynn glanced at the graph of the serum proteins, separated by size and electric charge, which she now knew considerably more about, having just read the Wikipedia article within the hour. To her it looked like a squiggly range of mountains drawn by a child. A definite narrow spike in the gamma globulin range interrupted the otherwise smooth contour. The spike wasn’t nearly as tall as Morrison’s, but otherwise it was in a similar location.
“What do you think?” Dr. Erikson said.
“I guess I think that is not normal,” Lynn said. Medical students learned to hedge their bets. “What I don’t know is if it qualifies to be called a gammopathy.” She had also reread the gammopathy article and felt reasonably capable of holding up her side of a conversation.
“Does it surprise you?”
“I suppose so,” Lynn said. “If it is a gammopathy, he seems too young for it. I’ve read that gammopathies are not common until after age fifty, and he is only twenty-nine, the same age as Scarlett Morrison.”
“But this is not a gammopathy, merely a possible warning he might develop one. He will need to be followed. If the spike enlarges, we’ll have to do a bone marrow exam to access the plasma cell population.”
“What does it mean if it increases?”
“It depends on how high it goes. A spike like that means that he is producing a particular protein. In someone as young as this it would be called a ‘paraprotein abnormality of undetermined significance.’ But then again, the spike could be the precursor of something more serious, like multiple myeloma or a lymphoma.”
“Interesting,” Lynn said, to say something. She was tempted to mention Ashanti Davis and her diagnosis of multiple myeloma, but she held back for fear that Dr. Erikson would ask how she knew about the woman. Instead she said, “I’m afraid this is all a little over my head. But why do you think he has developed this paraprotein? This morning you said it didn’t have anything to do with anesthesia.”
“Absolutely not!” Dr. Erikson said with a touch of the same irritation she’d exhibited that morning, making Lynn inwardly cringe. “I am one hundred percent certain it had nothing to do with anesthesia.” Then, catching herself, she said more calmly: “I’m sure he had this serum protein abnormality, or at least a tendency for it, prior to his operation. No one knew because there hadn’t been any reason to do a serum electrophoresis. A low-level abnormal paraprotein like this would be entirely asymptomatic. I’m just surprised you bring up the anesthesia issue again. Has someone raised this idea in the Anesthesia Department?”
“Not that I have heard of,” Lynn said. She tensed. She certainly didn’t want to talk about the Anesthesia Department and possibly reveal she wasn’t taking an anesthesia elective.
“It’s an absurd association,” Dr. Erikson added. “But if you hear of any reference to gammopathy in any context in the Anesthesia Department, I would like to hear about it, just as I’d like to hear if you or anyone else comes up with any conclusions about how these two patients suffered comas.”
“Of course,” Lynn said to be agreeable, again tempted to mention that there had been a third case, not two, but she held back for the same reason she had earlier.
“In return, I’ll keep you abreast of any changes with this case. Now that there has been a formal consult, I will be following Mr. Vandermeer, even when he gets transferred over to the Shapiro.”
“What?” Lynn said explosively enough to cause Dr. Erikson to jump. Although Lynn’s voice hadn’t been that loud, it was magnified by the subdued environment in the ICU. It was a place where everyone was tense. When things went wrong, and they occasionally did, they went really wrong.
Although Lynn had understood there was a chance that Carl might be sent to the Shapiro Institute at some point, the fact that it might be imminent dismayed her. Even though she knew his prognosis for recovery was gloomy, she also knew that his being transferred to the Shapiro meant that the neurology team was giving up, and she would have to relinquish the modicum of hope she had been vainly trying to hold on to. With an attempt to modulate her voice, she asked: “When is this supposed to happen?”
“You seem upset?” Dr. Erikson questioned. She stared at Lynn.
“I had no idea a transfer was being considered,” Lynn said, trying to recover her composure and suppress her emotions. “Dr. Stuart, the resident, didn’t mention it.”
“I can’t imagine why,” Dr. Erikson said. “The neurology team suggested the move, and they’re in charge. Since the infectious disease consult has come up with nothing, it might be soon. If I had to guess, I’d say he might be transferred as early as this afternoon or this evening. Certainly by tomorrow morning at the latest. He hasn’t had a gastrostomy for nutrition yet, but Shapiro patients are routinely brought over here if surgery is indicated.”
“It seems so soon,” Lynn said despite herself.
“He’ll get better care over there for his condition,” Dr. Erikson said. “That’s the point.”
“Have his parents been informed?”
“Of course!” Dr. Erikson said. She looked at Lynn askance, questioningly. Then she added, “The parents are very much involved. I’ve have seen them in here on several occasions. I mean, everyone knows that admission to the Shapiro Institute is voluntary. The family has to agree. Most do when they learn how much it is for the patient’s benefit.”
“What about his blood count?” Lynn asked quickly to change the subject. “Have the lymphocytes continued to go up? What if this paraprotein problem continues?”
The hematologist didn’t answer immediately. She stared at Lynn with such intensity that Lynn thought the worst. She worried she had given herself away and that the very next question would be a demand to know exactly what Lynn’s relationship was with the patient. But to her relief, when Dr. Erikson spoke it was just to answer her question. “The white count has gone up to fourteen thousand, with most of it lymphocytes.”
“Interesting,” Lynn said insincerely. Suddenly all she wanted to do was get away. As upset as she was about Carl’s possibly being sent to the Shapiro, she truly feared that if the conversation continued, she’d end up exposing herself as hardly a disinterested party. But she stayed where she was. They talked for a short time abou
t bone marrow function and the origin of the various blood proteins, but Lynn wasn’t concentrating. As soon as she could, she said she had to get back to the OR and excused herself.
“Remember to get in touch with me if you come to any conclusions,” Dr. Erikson called after her. “And I can keep you up-to-date about Vandermeer and Morrison. I’ll be following both patients at the Shapiro.”
Lynn nodded to indicate that she had heard and then quickly left the ICU. As she hustled down the central corridor, she tried to calm herself. She felt a sense of panic now that Carl might be physically taken away from her. It meant that she wouldn’t be able to check on how he was doing or the kind of care he was getting. First it had been his mind and memories that had been stolen, and now it was to be his body.
Lynn knew all too well from her brief student introduction to the Shapiro Institute that only immediate family were allowed to visit a patient, and only for brief periods scheduled in advance. And the visits weren’t much. The family members could only observe their loved one through a plate-glass window in order to protect the inmate from outside contamination. Some families complained but ultimately they understood it was for the patients’ collective benefit.
Lynn shuddered to think of Carl locked away in such a dehumanized place, remembering her student visit two years before as if it were yesterday. The tour that she and her classmates had been given had been restricted to a conference room and then to one of three visitation rooms where family member visits took place, both located in the institute immediately beyond the connector to the main hospital. The area beyond the plate-glass window in the visitation room was like a stage set where the unconscious patient was placed on what looked to be a regular hospital bed but wasn’t, with its unique structure camouflaged by the bed linens. The patient transport was fully automated, reminiscent to Lynn of an assembly line in an automobile plant.