“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 about 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.
Lynn remembered a mannequin had been used, not a real patient. Lynn and her classmates had been duly impressed at the demonstration. There hadn’t been any real people involved. The whole back wall of the set had opened and the mannequin had arrived automatically by the use of robotic equipment, placed in the ersatz bed in a matter of seconds, and covered up to the neck with a sheet. At that point all the machinery folded back into the wall and disappeared. The students were told that the immediate family members didn’t see the comings and goings; they were brought in only after the patient was already positioned.
Lynn and her friends had speculated about what the rest of the Shapiro Institute must have been like to enable them to take care of a thousand or so vegetative patients, which is what they had been told was projected to be the average occupancy. They were never given specifics above and beyond told only that automation and computerization made it all possible.