“All right, but it’s got to be takeout and fast,” Lynn said. “There is a narrow window of opportunity. She’s about to start a case. She even warned me ‘not to dawdle.’ Can you believe it? I don’t think I have ever heard anybody use the word dawdle.”
“You are certainly looking for ways to fault her,” Michael said. “Dawdle is a perfectly fine word. You catch my meaning, right?”
“I suppose,” Lynn agreed reluctantly.
Lynn was willing to take the risk of going via the cafeteria because she knew what food meant to Michael. She teased him on occasion that he was a growing boy. Taking the time now to get him some food was a way of showing her appreciation that he was willing to come with her to talk to Wykoff. As a realist, she knew she probably needed some protection from herself, and he was the one to provide it. She couldn’t help but feel anger toward the woman and knew that expressing it would certainly be counterproductive.
The visit to the cafeteria was appropriately short. They grabbed a couple of bread rolls and some fruit at the register to eat on the run. As far as Lynn was concerned, there was another reason it was good that they did not stay. In her fragile emotional state, she didn’t want to take the chance of running into anyone who might ask about Carl’s surgery.
Five minutes later when they arrived outside the anesthesia office door, Michael pulled Lynn aside. “Wait a second,” he said. “We have to think what to say if Wykoff asks why we are interested in Carl’s case and how it was we read her note. She’s bound to ask us, and we can’t use the anesthesia story.”
“Obviously,” Lynn said. Because of the detour to the cafeteria, even though it was short, she was particularly impatient to get inside the office. She was afraid of Wykoff being called out at any moment and cutting the meeting short.
“The only thing that comes to mind,” Michael continued, “is to say we are on a neurology rotation, which I suppose is a laugh. It means we use anesthesia for neurology and neurology for anesthesia.”
“I don’t know,” Lynn said hesitantly. She didn’t like the idea and struggled to find another. “I agree she might ask, just like she might be touchy about Carl’s disaster. The problem is that it’s too easy for an attending like Wykoff to find out we’re lying. All it would take is one phone call, and we’d be in deep shit, and all doors for finding out about Carl would slam shut. No, we have to come up with something else so we’re not lying. Why don’t we say we are researching hospital-acquired morbidity? At least it’s true.”
“I’m not sure saying we’re studying hospital-acquired morbidity would be much better,” Michael said. “With the administration, the idea of its own medical students researching something like that will go over like one of Ronald’s bad jokes.”
“Well, I can’t think of anything else,” Lynn said. “I think we’re stuck with the morbidity angle. That is, if she brings it up. Maybe she won’t. Come on! We have to get in there!”
“All right,” Michael said, throwing up his hands. “You’re the boss.”
“Hardly,” Lynn said. Facing the door, she hesitated. Not knowing if they should just go in or not, Lynn knocked, thinking it best to err on the conservative side. The sign on the door just said ANESTHESIA. A voice from inside called for them to come in.
It was a relatively small office without windows. There was no secretary. The space had four modern desks supporting computer terminals to be shared by all the anesthesiologists to handle their paperwork. A large bookshelf ran along the right wall and was filled with anesthesia texts and journals. Dr. Sandra Wykoff was sitting alone at one of the desks. As the students approached, she motioned for them to bring over a couple of the other chairs.
“So...” Dr. Wykoff said once they were seated, “who, may I ask, are you?” She was looking directly at Michael, and unlike many of the other attendings, she maintained eye contact.
“Another fourth-year medical student,” Michael said. He was impressed that she continued to stare at him.
“And you are researching the Vandermeer case along with Miss Peirce?” Dr. Wykoff’s tone was surprisingly matter-of-fact, neither friendly nor unfriendly.
“Yes,” Michael said. He didn’t elaborate. He wanted this to be Lynn’s ball game. All he was there for was hopefully to keep Lynn out of trouble.
“Why are you two interested in this case in particular?”
Michael noticed that the woman’s gaze had now appropriately shifted to Lynn.
The students exchanged a quick, nervous glance. It was Lynn who spoke up: “We have become aware of the huge problem about hospital-acquired morbidity. We think this case fits that category all too well.”
Dr. Wykoff nodded and paused, as if thinking. Then she said, “Have you read my note in the Vandermeer chart?”
Both Lynn and Michael nodded, afraid of what was coming, namely a question as to why they were looking at the chart and under whose authority. But to their relief it didn’t happen. Instead the doctor asked, “What is it about this case that you want to discuss?”
“What the hell happened?” Lynn blurted out, causing Michael to wince inwardly. “I mean, how could a healthy twenty-nine-year-old man having routine elective knee surgery end up suffering brain death?”
“If you read my note, then you already know that nothing out of the ordinary occurred,” Dr. Wykoff said, seemingly not taking offense. Michael was both surprised and relieved. “The case was entirely normal. I thoroughly checked the anesthesia machine before the case and after. It functioned perfectly in all regards. The sources for all the gases and the gases themselves have all been checked and rechecked. All the drugs and dosages have been checked. I have gone over the case with a fine-tooth comb. So have several other anesthesiologists. Nothing happened that would have contributed to the unfortunate outcome. It had to have been some sort of idiosyncratic reaction.”
“There had to have been a screwup,” Lynn snapped.
Lynn’s tone and words made Michael now visibly wince. Before the doctor had a chance to respond, he said, “We did see in your note and in the anesthesia record that the blood-oxygen saturation suddenly went down.” He deliberately spoke in a measured tone as a counterpoint to Lynn’s outburst. “Do you or anyone else have idea of what made that happen?”
“The oxygen level did go down,” Dr. Wykoff said. “But it only dropped to ninety-two percent, which isn’t that low, and, just as important, it immediately began to rise. Within minutes it was back to near one hundred percent. But to answer your question, I have no idea why it went down. The inspired oxygen concentration and the patient’s tidal volume had not changed.”
Lynn started to speak again but Michael gripped her arm to keep her quiet, saying, “We imagine it must have been a very disturbing case for you.”
“You have no idea!” Dr. Wykoff said, and paused before adding, “I had never had a serious complication before this case. It is my first.”
“In retrospect, would you have done anything differently?” Michael asked, wanting to keep the conversation going but without being accusatory.
Dr. Wykoff took another moment to continue. “I asked myself the same question. But, no, I wouldn’t have done anything differently. I handled the case the same way that I have handled thousands of others. There were no screwups! I can assure you of that.”
“There had to have been something,” Lynn interjected, despite Michael still gripping her arm. Although her voice wasn’t quite as strident, it was still harsher than Michael thought appropriate. “There had to have been something out of the ordinary that you did even if you didn’t think it could have made any difference.”