“Very funny,” Lynn said. She pulled him into the room and kicked the door closed. “I know the place is a god-awful mess, but ignore it for the moment!” She guided him over to the desk chair, which was clear, like the bed, and made him sit. Pushing aside papers to create an open space on the desk in front of him, she put down all three anesthesia record printouts in a row so that they were visible at the same time.
“Okay,” Michael said. “What am I supposed to be looking at?”
“Remember this blip that Wykoff pointed out on Carl’s record?” Lynn asked, pointing it out.
“I call it a frame offset,” Michael said. “What about it?”
Using her index finger, Lynn pointed to the same upward jump in the vital signs on the other two printouts. “All three cases have the same distortion or whatever it is, and all at exactly the same time: fifty-two minutes into the case.”
“Yo!” Michael exclaimed, looking from one printout to the other. “Now, that’s a righteous pickup.” He glanced up at Lynn. “That’s big-time weird. What’s your take?”
“I haven’t the slightest idea,” Lynn admitted. “But it has to be significant. I wish I could ask Dr. Wykoff what she thinks.”
“That’s not going to happen.”
“Agreed,” Lynn said. “We can’t go to anybody in Anesthesia, at least not for the moment. We’re on our own to figure out what it might mean. But that’s not all. There’s one more surprise.”
“What? Was the timing of the low-oxygenation alarm the same, too?”
“No. It was close but slightly different in each case.”
For a moment Lynn didn’t move, just stared at Michael.
“Well?” Michael said impatiently. “You going to lay it on me or what?”
“You don’t see it?”
“You got the ball, twin. Either dribble, pass, or shoot!”
Again, with her index finger, Lynn pointed to a very small box in the right-hand corner of each record. It was labeled MACHINE, and in each case it had the same number: 37.
Michael again raised his eyes to Lynn’s. For a moment they regarded each other. It was Michael who broke the silence: “All three cases involved the same freaking anesthesia machine!” he exclaimed. “That’s also got to mean something.”
“The same anesthesia machine having the same blip at the exact same time in all three cases. Statistically that happening by chance is nil. With two cases, maybe, but with three, no way.”
Michael looked back down at the anesthesia records. “I agree. But what do we do about it? Should we tell someone, and if we should, who?”
“It’s got to be significant, which means something weird is going on, but I can’t come up with a single, even potentially plausible explanation. And there is nobody we can go to with this without incriminating ourselves big time. The only thing I can think of doing is getting more info out of Shapiro.”
“This timing thing is what amazes me,” Michael said, looking back at the records.
“It more than amazes me,” Lynn said with sudden ferocity. “My intuition is ringing alarm bells, especially when I combine this timing issue with what I have learned from all these other printouts.” Lynn wildly gestured toward all the articles littering the floor. “And then with Carl going there...”
“Whoa, girl!” Michael cautioned. “Get a grip! You have to slow down. Remember, Carl’s not been sent to the Shapiro yet.”
“Morrison has, and Carl’s case is just like hers.”
“True, but you’re jumping the gun, my friend. Listen, I don’t mean to sound patronizing, but you are under a lot of stress! I think you need some food and a good night’s sleep and then you can reboot. Let’s go back over to the hospital and get dinner.”
“Of course I’m stressed,” Lynn snapped. “And I know I’m exhausted. But I’m not sure I could sleep even if I tried. I mean, why are they rushing to transfer Carl and Morrison? It’s way too quick in my estimation. Maybe the same thing happened with Ashanti. But why? What’s the rush? It can’t just be economics. Maybe it’s for better care, but I just don’t know.” Lynn again gestured toward all the printouts scattered about her room. “These articles point out there are always a few patients who defy the odds and wake up. Carl’s problem is less than thirty-six hours old. Why transfer him so soon? What if he wakes up in the Shapiro? With all the automation that is involved over there, would someone even notice? Whether my getting in the Shapiro can answer such questions, I don’t know, but somehow I think there’s a chance. I have to do it!”
Michael nodded. The last thing he wanted to do was make Lynn more upset than she already was. Instead of arguing with her, he glanced down at the floor and picked up the nearest article. It was the article that he and Lynn had read in the neuro ICU after seeing the Morrison chart, the one titled “Monoclonal Gammopathy of Undetermined Significance.”
“So let me guess,” Michael said finally, as he quickly flipped through the printout for a second quick read. “You’re thinking that this paraprotein stuff has some significance.”
“I do!” Lynn said. “I have no idea how or why or anything. But it seems that a paraprotein was or is involved with all three patients. Well, we don’t know for sure if a paraprotein was involved with Ashanti, but the fact that she has multiple myeloma is at least suggestive. It’s the worst-case scenario for a paraprotein gammopathy.”
“Seems to me you are heading out into the stratosphere on all this, if you don’t mind my saying so,” Michael said. He shook his head as he reached down for another article. This one was titled “Monoclonal Antibodies.” He began to speed-read it.
“You might be right,” Lynn said. “But remember what you said was on the home page of Ashanti’s Shapiro EMR: drozitumab. Remember?”
“Of course I remember,” Michael said.
“Do you remember what drozitumab is?”
“Of course,” Michael repeated. He glanced irritably at Lynn. He was losing patience. She needed food, and she needed sleep. And he needed food, too. “What is this, a test?”
“Drozitumab is a monoclonal antibody, like you said this morning,” Lynn added, ignoring Michael’s mild peevishness. “It is used to treat a kind of muscle cancer, not multiple myeloma.”
“I said I remember,” Michael repeated.
“If Ashanti is given drozitumab and had a serum plasma protein test, it would show up as a paraprotein.”
“I suppose you are right. What’s your point?”
“I don’t know. I’m thinking out loud and asking you to do the same.”
Michael shook his head. “It’s a mystery. There are too many loose pieces.” He went back to reading the article on monoclonal antibodies.
“Why was drozitumab put on the front of Ashanti’s record?” Lynn asked.
“Like I said this morning, I have no idea. Do you?” Michael didn’t look up from his reading.
“No, I don’t,” Lynn admitted. “But if I had to guess, I’d say that maybe they are trying it as a treatment for multiple myeloma.”
Michael raised his eyes and looked at Lynn. “You mean like just trying it to see if it might work without any specific scientific rationale, sorta shotgun style? That’s questionable, my friend.”
“I know that doesn’t make any sense,” Lynn agreed. “Okay, scrap that idea! Maybe it is simpler. From reading these articles about monoclonal antibodies forming the basis of biologic drugs, I know they have been having some problems. Maybe they are giving Ashanti various forms of drozitumab to see which ones cause less of a reaction.”
“That sounds a lot more probable than the shotgun treatment idea. Of course it means they would be using her as a guinea pig. Do you really think that might be happening?”