Robin Cook - Host

The trouble was in some respects that she knew too much. If she weren’t a medical student she could have hoped he would just wake up and be fine, which was what the Vandermeers were apparently assuming. Lynn wished she could indulge in such optimism, but she couldn’t. She knew that wasn’t going to happen. The neurology resident expected the MRI to show in detail extensive laminar necrosis of the cortex, whatever the hell that was. Yet she was knowledgeable enough to know that it meant the death of a lot of cells in the part of the brain that made people human.

Translated, it meant that even if Carl were to wake up, he wasn’t going to be the same Carl. There wasn’t going to be a happy ending, no matter what. It was a lose-lose situation. For a brief second she thought that it would have been better had he died, but then she quickly amended the thought, embarrassed at its selfishness. At least now there was a glimmer of hope, no matter how unlikely. He was, after all, still alive. Maybe there could be a miracle.

Pulling on her white coat, Lynn looked back at her image in the mirror. Her lips, normally full, were compressed in a grim line. Her green eyes stared back with hostile intensity. She was now clearly in the anger stage of her grief reaction, having already abandoned the first stage of denial. She couldn’t help but feel that the American medical system had failed her again. The first time had been in relation to her father, Ned, who had been unlucky enough to have had a rare genetic blood disease called by the acronym PNH. It was one of the so-called orphan diseases that affected fewer than ten thousand patients worldwide. After almost four years of medical school, Lynn knew a lot more about the disease than she did when she was in college. She understood now how the disease destroyed red blood cells during the night. She also knew she didn’t have it and wasn’t a carrier.

In 2008, when Lynn was a sophomore at college and the recession hit, Ned had lost his job and, with it, his health insurance. The health insurance had been paying the extraordinarily high cost of the medication that was keeping him alive. Although Ned had been able to pay the premiums himself for a year, the insurance company voided the policy as soon as they could, as it was before the Affordable Care Act. That meant no lifesaving drug, which ultimately meant Ned’s death. At the time Lynn didn’t know all of these details, just that the family was in difficult economic straits. When she did learn what had happened, it helped solidify her desire to go into medicine to try to change the system, especially after learning that the exorbitantly priced drug was so much cheaper in Europe and even in Canada. Now she felt the US health-care system had come back to bite her again.

To pull herself together, Lynn splashed cold water on her face. Behind her she saw the tall figure of Dr. Scott come into the changing room and go to her locker. For a moment Lynn debated whether she should go over to talk with her and ask if she would help look into what had happened to Carl, but Lynn rapidly changed her mind. It was too soon. She recognized she didn’t know enough even to ask intelligent questions, like how often something like Carl’s case occurred around the country. At the moment all she knew was that it had happened twice at Mason-Dixon Medical Center, only a few months apart.

Instead of talking to the surgeon, Lynn concentrated on leaving before Dr. Scott happened to see her. She didn’t want to talk to her or anyone. She knew she was on thin ice emotionally, especially now that her anger was trumping her denial.

Lynn used the stairs to avoid running into anyone she knew in the elevator. Once on the ground level, she ducked through the clinic building, which provided a shortcut to the dorm. She made it a point to steer well clear of the clinical amphitheater, where the ophthalmology lecture was being held.

Emerging from the hospital confines into the glorious Charleston mid-spring sunshine, Lynn felt a modicum of relief just to be outside. With the birds singing and the warm sunshine knifing down through the flowering trees in the landscaped quadrangle of the medical center, she tried not to think. But it was an effort to keep her thoughts at bay, and it didn’t last. Off to her right was the immense hulk of the Shapiro Institute, loudly reminding her of the plight of the brain dead.

In sharp contrast to all the other buildings forming the Mason-Dixon Medical Center complex, the Shapiro Institute seemed to be only two or three stories tall. It was hard to determine, since it had almost no windows, making it appear as a monstrous rectangle of polished granite. Lots of flowering trees and shrubs were planted around its perimeter in an attempt to soften its stark lines. There was only a single, solid, blank entrance door set back under a stone arch along its facade. There had been times when Lynn and Michael were walking back from the hospital when shifts at the institute must have been changing, and they saw personnel emerge. There were never many people. Those they did see were always dressed in unique white uniforms, something akin to surgical scrubs but more stylish and form-fitting even though they were one-piece coveralls.

Stopping for a moment, Lynn stared at the building, wondering if Ashanti Davis was still there, and if she was, how she was doing. Lynn shuddered, wondering what it would be like for Carl if he were moved into the facility and whether she would be allowed to visit. She doubted she would, since she was not immediate family.

She thought back again to the single second-year official tour that she and Michael had had, along with their classmates. She clearly remembered the details of the story behind the name. It was in honor of Arnold Shapiro, a twenty-one-year-old college student from Texas, who ended up in a persistent vegetative state for fifteen years. The immediate cause of his condition was thought to have been hypoxia. His heart had stopped spontaneously and there had been a delay for an unknown period of time before he’d been resuscitated by EMTs. The case had ignited a fierce legal battle between Arnold’s divorced parents whether to maintain him indefinitely or to discontinue the feeding tube and let him die. Ironically the case became a poster for both sides of the issue. Lynn and Michael had been told that the rationale for naming the facility after Arnold Shapiro was because throughout his ordeal Arnold had received excellent care from being in the spotlight. The goal of the Shapiro Institute was to give that same level of care to anyone who needed it, whether famous or not.

Thinking of Carl possibly getting shuttered away for years made Lynn shudder again and turn away from staring at the building. Quickly she recommenced walking toward the medical school dorm. She knew she had to get a grip on herself.

The dorm room she had occupied from the first day she had arrived at medical school was on the fourth floor. It was small but pleasant, and most important it had an en suite bathroom. The window looked out across the Cooper River with a view of the graceful Arthur J. Ravenel Jr. Bridge arching over to Mount Pleasant. The river was wide at that point and looked more like a huge lake.

There was a framed photo of Carl on top of the bureau. Carl was laughing and holding up a pina colada, complete with a pineapple wedge, a maraschino cherry, and a miniature paper umbrella. The photo had been taken that past summer on his twenty-ninth birthday at Folly Beach, a popular nearby resort. They had rented a small but charming cottage for the weekend.

Lynn reached out and turned the photo over. It was painfully reminiscent of a different time and place. After tossing her white coat over the back of her desk chair, she changed into more appropriate biking clothes and grabbed her helmet, backpack, and sunglasses. In the backpack went her cell phone, a fresh legal tablet, and a couple of pencils. Other than her bike helmet, she didn’t need anything else, since she had gradually stocked some basic clothing and toiletries at Carl’s house.