Monday Mornings: A Novel
For my beautiful wife Rebecca and our three wonderful daughters—Sage, Sky and Soleil. Be lifelong students and also wise and patient teachers. Remember to “see everything, overlook most and correct a little.”
Also, for all the healers out there who continuously strive to perfect the “practice” of medicine.
To the staff and faculty at the University of Michigan hospitals, and the residents of idyllic Chelsea.
And finally, for Dr. Julian T. Hoff. I thought of this book many years ago when you took on the task of training me. Thanks for all the lessons, inside and outside the operating room.
Bob Barnett is my lawyer, and also my friend. He has made my writing career a reality, and I am honored to have his guidance. Jamie Raab is the “boss” at Hachette, and has never hesitated to publish one of my books. Thanks so much for the opportunities. My editor Deb Futter skillfully guided my editorial process, prodded me just enough to stay on schedule, and cheered loudly along the way. Dianne Choie made the whole process hum along, even at times when it seemed as though the end would never come. And thank you to the countless editors who internalized
Strunk and White
in a way I didn’t think possible and allowed me to benefit from their skills. Thank you for your dedication.
Dan Barrow is the chairman of neurosurgery at the Emory Clinic. He is the boss in my medical world, and my friend. Thank you for all your guidance and wisdom. I hope this book honors some of the medical and surgical traditions we have discussed.
The indefatigable Roni Selig runs our medical team at CNN and manages an incredibly productive and busy unit of a couple dozen producers. Her constant support and encouragement is priceless. Thank you for listening to my ideas and helping focus them.
And finally, most importantly, thank you to my friend and fellow writer David Martin. For decades, David has been the kind of writer I hope to be one day. Simply put—this book and many of the projects I do on television would not be possible without him. Thank you, David.
T
he EMTs crashed through the swinging bay doors of the emergency room. Wearing bright blue polyester jumpsuits with a yellow insignia on the left front pocket and standard-issue black boots, they were moving fast. It was impossible to miss the concern, and also the soot, on their young faces. Wherever they were, there had clearly been smoke, probably a fire. Between them was a woman on a gurney, in a silver reflective thermal cocoon. An IV bag, slowly dripping into plastic tubing connected to her arm, swayed wildly on a pole as they wheeled her toward the center of the crowded emergency room.
It was only when you saw the ER from the top that you understood the ingenuity of the layout. It was not a single room, but an apparent maze designed like a large round tire with a series of spokes. There were rooms around the periphery; patients were placed closer and closer to the middle depending on how critical they were. This woman was coming to the epicenter.
“I got an attempted suicide. Single vehicle into a telephone pole.” The EMT’s voice carried across the ER, above the urgent voices of doctors and nurses, the moans of patients, a crying baby, the beeping monitors, the adjoining waiting room’s blaring television.
Dr. George Villanueva was the man who lived and worked in the center of the ER, and his eyes were on the woman even before the words reached him. Villanueva was a gargantuan man who sat on a swivel stool that was barely able to contain his significant girth. He gave the impression of an elephant in the circus—or perhaps a supernova at the center of a solar system. He had followed the patient as soon as her small prone form came into his ER. From his perch, Villanueva immediately noted that her face, immobilized by a slightly crooked, hard plastic neck brace, was unlined. He guessed her age as twenty-five. She was pale. Her lips were almost bluish in tint. Her nose looked as though it might have been broken by the air bag, and deep bruises were beginning to bloom below the orbits of both eyes. “Raccoon’s eyes,” he muttered to himself. It was an indication that the base of the young woman’s skull had been smashed. He quickly counted the number of drips from the IV bag. “Too slow.” The paramedics repeatedly squeezed a bag connected to a breathing tube, forcing air into her lungs. “Also too slow,” he mumbled.
“Trauma Bay Eight,” Villanueva shouted, sending the patient to the trauma bay near the center of the ER. The doctor’s small brown eyes locked on the woman, his massive, watermelon-size head pivoting on his even more massive torso like some sort of giant Claymation figure. As the EMTs veered past Villanueva, he continued to make mental notes. He noticed that her eyes were open but pointing in slightly different directions, with one pupil a little larger than the other. She was weakly moving both her arms beneath the foil blanket. He glanced down to the catheter bag, draining the young trauma victim’s bladder. It was nearly empty. Her heart monitor beeped too fast. Villanueva calculated 124 beats a minute.
“What’d you say happened?” Villanueva called to the paramedics.
“Tried to flatten her Camry into a telephone pole. No skid marks. Didn’t even try to stop. Suicide by car, without a doubt,” the EMT answered without stopping, sweat dripping from his brow.
“Like hell,” Villanueva said. He launched his 350-pound frame off his stool and caught up to the fast-moving EMTs. He moved with an extraordinary grace for such a big man, and the speed at which he crossed the tile floor was startling. There was still the glimpse of the agility that had made him the Detroit Lions second-round draft pick out of the University of Michigan. Now he strode step for step with the EMTs as they raced toward the trauma bay. Villanueva looked as though he were leading a sweep. He’d lasted four years in professional football before his relatively diminutive 275 pounds became a liability. By the time he left the league, even high schools had three-hundred-pounders on the offensive line. Of course, Villanueva’s weight was now well into the acceptable range for an NFL offensive lineman. But instead of a helmet and pads, he wore size XXXL scrubs that strained to contain his midsection, which had grown to enormous proportions in the twenty-two years since he had left the NFL. Often the scrubs failed, and a small rim of belly was visible beneath his shirt. Villanueva’s scrub pants were so tight that many of the nurses found them obscene. He usually had the decency to wear his white coat, which was the only thing big enough to cover the large man and all his parts. But today, the coat was lying bloodied and crumpled in another trauma bay. It was the casualty of an emergency resuscitation a few hours earlier.
As the paramedics slid the injured woman from the gurney to the examination table, Villanueva and an ER nurse converged on the spot. Villanueva reached down and quickly adjusted the woman’s neck brace so it was perfectly straight, then glanced at the closest EMT.
“Turn up her oxygenation, increase her ventilation, get her some more fluids, and call the neurosurgeons. This wasn’t a friggin’ suicide attempt. She just had a bomb go off in her head! Stop screwing around. Let’s go!”
The nurse hesitated for a split section, considering whether to deny that she was screwing around, thought better of it, and began moving around the injured woman, turning a large valve to increase the flow of pure oxygen through a clear mask.
The paramedics looked at each other and shook their heads in wonder as though they had just seen their favorite magician performing another mind-bending trick. Then they began retracing their steps through the emergency room, their radios squawking, and their black laced-up boots leading the way.
Villanueva’s impulsive diagnoses were the stuff of legend around Chelsea General. His quick thinking and physical agility earned him the nickname El Gato Grande—the Big Cat—or simply Gato. Dr. George Villanueva himself spoke only a smattering of Spanish, and he hadn’t gone by his given name, Jorge, since he was six and started school. Still, the Gato Grande
nickname stuck.
Earlier that same shift, Villanueva had been on his stool watching the actions of two emergency room doctors in a close-by trauma bay. They were arguing back and forth when their patient’s blood pressure started to plummet. If you had been watching Villanueva closely, you would’ve seen a flush appear on his cheeks and a nearly imperceptible squint in his eyes. It was vintage Villanueva, and not a look you would ever want directed at you. A second later he’d had enough and burst into the room while the two emergency room doctors were unsuccessfully trying to revive a man in his sixties. One of them had his mouth to the patient’s ear and was shouting, “Sir, can you open your eyes?”
“No…he can’t…” Villanueva angrily mumbled as he strode toward the slumped man, almost gliding on the balls of his feet. He grabbed a bottle of iodine in his left hand and an enormous sixteen-gauge Cook needle in his right.
He told the ER doctor to “please step aside” and when the man didn’t react fast enough, Villanueva swept the MD aside with his forearm, the way he might have handled a defensive back in his previous career. Before the doctor could protest, Villanueva had pulled the patient’s shirt open and was squirting iodine onto his left chest to sterilize the area. A second later Villanueva plunged the needle deep into the man’s chest. A faint smile crossed his face as the needle found its mark. He pulled back on the plunger, and the syringe started to fill with bright red blood.
“Cardiac tamponade,” he said to no one in particular. “Five. Four. Three. Two. One.” Villanueva paused. Nothing happened. He gave another squint to the monitor next to the patient. “One half.” Suddenly the patient’s blood pressure and heart rate normalized as the pressure was relieved around his heart. The patient’s skin started to pink up. “Zero.”
Villanueva turned and walked away.
The other doctors in the room were stunned. They had missed the problem, almost costing the man his life.
“There was nothing to suggest this man had a tamponade,” the ER doctor stammered to the receding Gato Grande. Villanueva didn’t look back, instead tearing off his now-bloodied white coat and throwing it into a passing bin of laundry.
T
he jacketless Villanueva strutted back across the emergency room toward his stool, his head held high as he passed the nurses admitting, the kid getting his head stapled, the group of obstetricians trying to coax a young fetus to stay in its mother’s womb, the drunk who fell off his roof, and a businessman in a suit who had been complaining of chest pain. A medical student who looked as though he’d be much more at home in the library stacks than the ER caught up to Villanueva. The student carried a clipboard and a quizzical expression. He was now rapidly turning his head back and forth between the young woman Villanueva had diagnosed with “bomb in head,” and Gato himself.