Robin Cook - Host

Lynn biked due south until she could veer off onto Morrison Drive, which eventually turned into East Bay Street and finally into East Battery. It was a progressively scenic route the farther south she went, especially when she reached the historic downtown district. When she got below Broad Street, where most of the historic homes were located, she passed the area called Rainbow Row, a series of early-eighteenth-century row houses that had been built on the edge of the Cooper River. They were all painted in historically accurate pastel Caribbean colors, a legacy of the English settlers from Barbados. Lynn’s mood cheered a smidgen. Charleston was a beguilingly beautiful city.

Monday, April 6, 2:05 P.M.

Michael slipped his pen into the pocket of his white coat. He had tried taking notes to keep focused, but it wasn’t working. The main problem was that the lecture wasn’t about clinical ophthalmology, as he had expected. Rather it was a tedious review of the anatomy of the eyeball and its connections to the brain. It was material Michael and his classmates had studied extensively during their first year.

One of the secrets to Michael’s academic success was that he could speed-read with remarkable retention. He had worked laboriously on the skill from early childhood, always careful to keep his developing proficiency a secret from his friends, particularly his male friends and particularly in high school. In the social circles he ran in, being a good student and the effort it took weren’t assets. On the contrary, they were suspect.

As far back as Michael could remember, his hardworking mother, who cleaned houses and washed other people’s clothes, had harped on the belief that education was the express train out of the ghetto poverty trap, and that speed-reading was the ticket. Michael had taken the advice to heart, and, thanks to good genetics inherited from his mother and the father he had never really known, he had had the ability to master it. Now, with his medical residency in the bag, suffering through a two-hour marathon review of material he had already been sufficiently exposed to was a ball-buster. The reality was that he could relearn what was being presented on his own in a fraction of the time and with better recall. It was also true that his mind was wandering. He couldn’t stop thinking about Lynn, Carl, and, of all people, Ashanti Davis.

Michael glanced around at his classmates. It was obvious that just about the whole team was suffering. Those students who weren’t sleeping had glazed eyes, suggesting to him that only a handful of neurons in their brains were functioning. “Fuck this,” Michael said to himself. “I’m breaking out!”

Taking advantage of the dimming of the lights for yet another series of computer-generated images, Michael impulsively got to his feet and left. It took only a moment since he had taken an aisle seat in the rear, near the exit. Still, he knew he risked being noticed. As a black man entering into a profession where the percentages of black male physicians were low and falling, anonymity for him was rarely an option.

The clinic was in full swing. Every available chair was occupied by a patient. A number of them looked up hopefully when they glimpsed Michael and his white coat in hopes that their waiting was about to end. None of them had any idea their waiting was due to a lecture. Many of the white patients quickly averted their gaze. It was similar to the lack of eye contact with the attending physicians, the vast majority of whom were white, that had bothered Michael during his first year, when there was an introduction to patient contact. Now he took it in stride. He correctly realized it was their problem, not his.

Michael had good rapport with patients white and black once they got over the initial hesitation his blackness occasionally engendered. In fact sometimes the white patients adjusted faster. Some blacks would assume that Michael was an “Oreo,” a black-vernacular label for someone overly assimilated, or “black on the outside and white on the inside.” But that surely wasn’t the case. Michael fully identified with his roots and the black community, and intended to serve it by bringing Harvard know-how back to Beaufort, South Carolina.

Intending to head over to his dorm room to search for Ashanti’s anesthesia record, Michael left the clinic by the same exit that Lynn had used earlier. As if further mimicking her, he stopped in the landscaped courtyard at just about the same spot that she had and gazed at the Shapiro Institute for the same exact reasons. He wondered if Ashanti Davis was still in there, being kept alive by the wizardry of modern medicine. He also worried whether Carl was destined to be transferred in there as well. He knew that would be a major stumbling block for Lynn.

Michael was well aware, at least theoretically, that a patient in a vegetative state could be kept alive almost indefinitely. He knew there had been a patient who had been kept alive for thirty-seven years. What it required was not rocket science but merely a careful balance of the body’s internal environment, meaning proper hydration and electrolyte balance, appropriate nutrition, and careful skin care. For long-term nutritional needs, the best solution was a percutaneous gastrostomy tube, placed by surgery through the abdominal wall directly into the stomach.

Of course, another major requirement was to keep all the various microorganisms at bay, such as bacteria, fungi, and viruses, since it was often the case with such patients that their immune systems weren’t up to snuff. Appropriate drugs such as antibiotics and antivirals were used when needed, but the main defense was accomplished with reverse precautions, meaning to keep the bad bugs away from the patients. Prevention of infectious disease was the reason visits to the institute were restricted to immediate family, and even these were discouraged for the patients’ collective benefit. Immediate family had to view their stricken loved ones through a plate-glass window.

From his rotation in the ICU during third-year surgery, Michael was well aware that the biggest threats for long-term care of unconscious patients were pneumonia and the lowly bedsore. Patients had to be turned constantly to avoid being in one position for too long, because that was how infections and pneumonia were fostered. The more mobilization, the better, which was why such care was generally considered labor intensive, except in the Shapiro Institute. On Michael’s one and only visit during the second year, he had learned that the Shapiro’s secret was computerization and automation. What that really meant, he wasn’t sure, because he and his classmates didn’t get to see any real patients. The visit had been limited to a didactic lecture and a short stint in a family visitation area, where a dummy had been used for demonstration purposes.

Thinking about Ashanti Davis and her ignominious end reminded Michael of his own success at having defied the odds. Here he was, about to finish medical school and head up to a medical residency in the lofty Ivy League while most of his childhood acquaintances were either already dead or in prison, or with severely compromised futures, like Ashanti. About a week earlier, as a way to chill out after the anxiety of the residency matching program, he had hidden in his room and social-surfed himself to near brain death, looking up as many of his old friends as he could, using multiple sources. It had been a depressing pastime, and it made him really question how he had been so lucky.

Mostly Michael gave credit to his mother and the way she ragged on him about education and reading skills. But he also gave himself some credit for not falling prey to the culture in which he had found himself immersed. Things could have worked out very differently, and he very well could have ended up a hashtag in Beaufort, South Carolina’s, homicide statistics. As a young, skinny teenager he had dealt drugs for a while, as it was an easy way to help support the family. He was also good in sports, and both activities pushed him to the head of the pack. But being at the head also meant trouble, and protecting his honor required quick response to threats. At first going to blows with fisticuffs was adequate, but by the eighth grade it meant having to pack.