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 check 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.”