Monday Mornings: A Novel (12 page)

Not many surgeons went on medical rounds, but Sydney found them interesting and went whenever she had time. That meant enduring the ribbing from the medical attendings: “How does an internist stop an elevator door from closing? With his hands.” Internists don’t need their hands. “So how does a surgeon stop an elevator door from closing? With her head.” Ba da boom. She thought too many doctors, once they had made the choice between surgery and internal medicine, never strayed across to the other side. Doctors who became internists stereotyped surgeons as scalpel-happy cowboys. Surgeons saw the other side as ineffectual practitioners who analyzed and diagnosed but couldn’t fix problems. There was some element of truth in both stereotypes, of course, but only some.

Her father taught economics at Furman, a small, liberal arts college in South Carolina, and her mother was a columnist at
The Greenville News
. When Sydney was in high school, her father had come upon Sydney reading an obscure history of the Algerian crisis and labeled her an autodidact. Sydney blushed, thinking he was referring what she had been up to in her bedroom when the lights were out and she thought her parents and sisters were asleep. She said nothing, but looked up the word as soon as she got a chance and realized her father was right. She really did like learning for the sake of learning.

In college, Sydney was a dual English–Biology major. She especially reveled in the mysteries that remained about the human experience. Why did we behave the way we did, and could it be predicted? How were genes connected to behaviors like compassion and morality?

She was fascinated by the basics of human development: How could the cells in the womb become differentiated and migrate where they needed to go as the fetus developed? She also relished arcane experiments that showed how people responded to the world around them: how those who took a dummy cancer drug in a clinical trial could lose all their hair (the nocebo effect); how a child could regenerate a fingertip but an adult could not; how people became happier in anticipation of a happy event, or died of heart failure after the death of a longtime spouse.

Joanna Whitman presented a mystery, and Sydney felt an intense clinical curiosity. She suspected something was seriously wrong with the woman, but she could not put her finger on it. The doctors who had treated her had never strayed far from the initial diagnosis of bronchitis. Once a doctor read the chart, he was most likely to continue down the same path. It was a group-think mentality that occurred too often in hospitals. That was always dangerous, Sydney knew. They should have expanded the possible list of diagnoses, but what would those other possible diagnoses be? Whitman’s heart rate was elevated but her lungs appeared clear. What was going on?

Now, at four in the morning, Sydney thought she knew. She stood by the window, the heavy rain beating an elaborate rhythm on the glass as she called the paging operator. She reached the junior resident on call at the hospital, a Dr. Tom Ottobrini.

“Dr. Ottobrini, this is Dr. Sydney Saxena. Mrs. Whitman needs a lung scan or a CT angio, and she needs it yesterday,” she said breathlessly.

The junior resident was groggy. “Joanna Whitman? You mean the bronchitis?”

“No. Not ‘the bronchitis.’ Pulmonary embolism. Listen, we’re damn lucky she hasn’t thrown a large embolism already.”

“Dr. Saxena. Aren’t you a surgeon?”

Sydney continued, “Wake up your attending. Do what you need to do, but you need to do it now. We’re lucky this poor lady hasn’t boxed already.”

“I don’t know.” The sleep-deprived resident now sounded suspicious, as though he were the target of some sort of prank. Residents never liked calling the attending—waking up their boss with questions that would show they were less than fully trained doctors able to handle whatever came their way. And they shared a special dread of waking up the senior doctor with a question or problem that was trivial or, worse, insipid.

“Listen, Tom, she’s circling the drain. Who’s your attending, Bobby Mitchell? Call him and blame it on me. We were in med school together at MGH.”

“All right, Dr. Saxena, thanks for your call.” The resident hung up. He sounded as though he was getting rid of a telemarketer.

Sydney was seething now. She skipped a shower, roughly brushed her hair, threw on pants, a blouse, and her white lab coat, and ran out of her town house. She forgot it was raining and didn’t bring an umbrella as she half walked, half ran to the car. The cold drops hit her like a slap.

Twenty minutes later and still wet, she was on the fourth floor of Chelsea General. The place looked like it was in state of hibernation. Most of the patients slept. Nurses were hunkered at their stations doing paperwork while they kept one eye on the monitors. A junior resident was walking the halls updating the prescriptions for the various patients.

Saxena walked up to a nurse.

“Joanna Whitman?”

The nurse checked the chart in front of her.

“Four-twelve.”

“Thanks,” she said. “Would you page Dr. Ottobrini and have him meet me there?”

“Yes—” The nurse squinted to read Sydney’s name tag. “—Dr. Saxena?” She clearly didn’t recognize the name.

Sydney walked down to the room. Joanna Whitman was sleeping, her breathing troubled. Sydney checked the chart. Her heart rate had been steadily rising over the last several hours.

She stepped into the hallway and almost bumped into Ottobrini, a rangy young doctor with puffy eyes, stubble, and an irritated look. Sydney was looking up at Ottobrini, but she took his irritated look and raised him a withering glare. No matter which side of the surgery-medicine divide she was on, Sydney was an attending, and he was a resident.

“Listen, Dr. Saxena, I called my senior resident and he said we shouldn’t bother Dr. Mitchell with this. He said to hold off—”

Before Ottobrini could finish his sentence, a balding doctor with stooped shoulders joined them. Ottobrini was surprised to see him.

“Bill?”

“Tom.” The senior resident turned to Sydney. “And you must be the intrusive Dr. Saxena.” Despite his words, he didn’t look or sound annoyed. A smile played at the edge of his mouth. He turned back to Ottobrini.

“Order a spiral CT for Mrs. Whitman.” The junior resident’s red eyes goggled. “Go on.” Ottobrini went into the room and started writing on Joanna Whitman’s chart.

The senior resident turned back to Sydney.

“Couldn’t get back to sleep after he called.” He held out his hand. “Bill McManus.”

“Sydney Saxena.”

“I pictured you bigger. Maybe with a long crooked nose. A wart on your cheek.”

“Give me a couple more years.” Sydney laughed. With a start, she realized it was her thirty-fifth birthday.

“I hope you’re right about this because up till now we haven’t had a clue.” Sydney felt a surge of admiration for this senior resident. Not many doctors were so willing to set aside their egos, even when the patient’s best interest might be at stake. He looked at Sydney for a second, and then awkwardly put out his hand. She shook it, firmly. “Okay, well, thanks. We will let you know what the test shows,” he said. She nodded confidently, and they separated, walking in opposite directions.

At noon, Sydney received a page to the fourth floor. “McManus,” a voice answered. Her suspicions were correct, he went on to tell her: Joanna Whitman had a pulmonary embolism and was already on an around-the-clock infusion of heparin. She had been throwing small emboli to her lungs, which were impeding her breathing and causing symptoms similar to a lung infection. Bill McManus paused after describing the results of the scan and then out of the blue, asked Sydney out on a date. Even though she was taken aback, she regained her composure quickly. And then, as she always did, she declined. She gave her pat answer and said she was committed. She didn’t tell him that she was committed to the hospital. At least she was still getting asked, even at the “advanced” age of thirty-five, she thought to herself.

A few days later, McManus ran into Sydney at Joanna Whitman’s bedside. Sydney wanted to finally meet the patient for herself. Whitman’s husband now looked exhausted and relieved, instead of exhausted and worried. An IV bag dripped the blood thinner heparin into the patient’s left arm. Sydney held her right hand.

“Well, look who’s here,” McManus said. Sydney couldn’t help but appreciate the obvious joy he took in seeing her.

“Mrs. Whitman, I’m betting she hasn’t told you this, and I’m embarrassed to admit this myself, but Dr. Saxena was the one who solved your medical mystery.”

Joanna Whitman looked up at Sydney. She squeezed her hand between her own.

“Thank you, honey. I was beginning to think I was going crazy. Making up the symptoms out of the clear blue.”

Sydney smiled.

“You take care, Mrs. Whitman.”

As Sydney turned to go, Whitman’s husband called after her. “Doctor.”

Sydney stopped. He reached out his bony hand and shook hers.

“Thank you. Thank you.”

T
hat afternoon, Sydney did what she’d done every year on her birthday since she’d turned thirty. She drove to the playground not far from her town house. The rain had pushed east but the clouds remained and there was a chill breeze blowing, a harbinger of winter. Still, the hardier young mothers—or maybe those suffering from cabin fever—sat on benches while their bundled preschoolers chased one another, climbed the ladders, went feet-first down the slide, or simply sat in the damp wood chips, lost in their own world. The mothers chatted, always with one eye on their progeny.

“Be careful,” they’d call out. Or, “Look at you!” to a little girl who went down a tornado slide. “Share!” to a boy who wouldn’t give up the wagon he was pulling. “Carter, do not throw sand!” Words of praise, advice, and discipline in the years-long quest to produce happy, successful offspring.

One of the mothers jiggled an old-fashioned, dark blue stroller as she watched a child ramble around the brightly colored structure. Now and then, she peeked at the baby, reassuring herself that the infant was still sleeping.

Sydney picked an empty bench and watched the children and the mothers. This was her annual test to see if she harbored a desire to join them. Sydney knew deep in her biology she was programmed to want to reproduce. To pass on her genes. To continue the unbroken succession of parents and offspring from the primordial seas to this playground.

Sydney checked her watch and then began soaking up the scene. She wanted to see if she saw in the children’s faces a hole in her own life. As she gazed at the mothers, she looked inward: Did she feel any pangs of jealousy? After twenty minutes, she decided she didn’t. None at all. No tightening of her gut or tugging at her heart or tears in her eyes or other physiological signs that might signal a longing for motherhood.

Sydney could appreciate the mothers’ tenderness, their devotion to their children, but watching them administer snacks, console hurt feelings, and tend bruised knees, she didn’t feel an iota of envy. In fact she would be incredibly bored if she swapped places with any one of these women.

Sydney was pleased. She had expected to marry Ross, devote herself to him, be one of those female doctors who shared a practice so she could have time to raise a family. When Ross told her of his 180-degree change of heart, a tearful confession in the car after the fateful dinner, she was devastated. It was as though he had punched a hole in her heart, and her hopes for the future had flowed out through the hole. Aristotle had called hope a waking dream, and that is what she was living in her romance with Ross. When she thought about it now, though, she realized she hadn’t really known Ross that well. It was the dream that attracted her.

After the breakup, Sydney stayed in bed for most of a week, getting up only to eat and go to the bathroom, and then it was over. She was done with him. More than that, she was done with the dream of sharing her life with another person, with the willingness to devote herself to pleasing a mate, or to make professional sacrifices for the sake of marriage. The weakness in her had been cauterized, she thought. She was now unencumbered, able to focus fully on being the best doctor she could be, and to one day be sitting in Hooten’s chair.

When half an hour at the playground had passed, Sydney got up and walked back to her car, convinced that she was content with her place in life for at least another year. Then she headed to the second appointment she made for herself each birthday: a massage. After that, she’d go back to the hospital.

CHAPTER 11

M

onday Morning. Six
AM
. The room smelled of freshly brewed coffee and shampooed hair. Most of the doctors in the room had on freshly pressed scrubs with a white coat, rubber clogs, and comfortable socks. They were easy to remove if you were sitting during a long operation, or were trying to catch a quick nap in the call room. It was as clean as you might ever see this group, save the few who had been on call the night before. They looked rumpled and tired, and were mostly huddled around their cell phones and computers, whispering orders to the ICU nurses. A few were trying to look relaxed and reading the newspaper, but the room was charged with anxiety.

Harding Hooten, Sydney Saxena, and Sung Park were in their usual spots in the front row. Hooten wore his trademark bow tie, and a heavily starched shirt. Villanueva sat in a middle row, looking like an Easter Island boulder that had been dropped in the center of the room. He had his game face on, a nasty-looking scowl that would intimidate the toughest defensive lineman, let alone any member of the medical profession.

Fresh from his own appearance in the spotlight, Ty sat near the back of the amphitheater, by himself. People entering the room shot him a look of pity, and subconsciously felt a little bit better about themselves watching a man normally made of Teflon have this tragedy stuck to him. “It was about learning and getting better,” these doctors had said to him when the topic had arisen. It was true. Ty’s experience had already changed the protocol for surgical patients throughout the hospital. At Chelsea General, the laboratory profile for a patient going to the operating room would now include a test for various clotting disorders, and every doctor would be sure to ask about a family history that included any signs of bleeding problems. The mistake Ty Wilson had made would never happen again. It was the essence of Monday Mornings. One of the chief residents had already submitted a manuscript on the surgical complications in patients with von Willebrand disease.