Of Flesh and Blood (32 page)

Tyler looked forward to lunches with his grandmother. His deep affection for her aside, Liesbeth provided a direct link to the memory of his grandfather and, especially, his mother. They had died within three years
of each other. Though they were arguably the two most influential people in his life, Tyler had trouble imagining how much Liesbeth must have missed her husband and only daughter. Despite the loss, and her debilitating arthritis, Liesbeth still managed to maintain a sunny disposition and upbeat outlook. Tyler wished he had inherited more of her resilience.

Wearing a pale sweater and black pants, Liesbeth had pinned her medium-length gray hair back with two hairclips. She possessed sharp Dutch facial features with high cheekbones and an upturned nose. Her kindly face was weathered with the same laugh lines Tyler remembered from childhood, but she never seemed to age further. And her laugh was as quick and vibrant as ever. Only her hands bore the brunt of her eighty-six years. They were knobby, swollen, and angled grotesquely at the knuckles and finger joints. Tyler was surprised they could still hold a fork and knife at all.

Noticing his gaze on her hands, Liesbeth put down the cutlery and clasped her hands together self-consciously. “It’s a blessing, really.” She spoke with a remnant of a Dutch accent. “They might not be pleasant to look at, but they do not hurt like they used to. The disease, my doctor tells me, is now ‘burned out.’ ” She laughed. “Much like the victim herself.”

Tyler grinned. “Hardly, Liesbeth.” He had been calling her by her first name for as long as he could remember. She never wanted to be called Grandma, or Oma, claiming the title made her feel too old. “You’re an inspiration.”

“You have always been such a little charmer. Even when you were five years old. Remember? You told me I was as beautiful as a queen.” She shook a crooked finger playfully at him. “Of course, you always wanted more licorice back then.”

Tyler laughed. “Got any on you now?”

Liesbeth ignored the joke. Her brow furrowed and she gazed at him for a long moment. “Tyler, what is bothering you today?”

Surprised, his hand stopped halfway to the coffee cup. He thought he had donned a convincingly brave face for their lunch. Of course, his grandmother had always been eerily insightful. “It’s been a tough week at work,” he said.

“Ah. I still remember how Maarten would bring his work home with him.”

Tyler leaned forward in his seat. “That’s something I always wondered
about. When Opa began in the 1950s, pediatric oncology wasn’t a real specialty. Chemotherapy and radiation therapy were just in their infancy. It was all wild guesswork. And the most common childhood cancer, acute lymphoblastic leukemia, was almost—”

“They all died, didn’t they?” Liesbeth interrupted with a knowing nod.

“Ninety-five percent of them, anyway. Now, it’s fewer than ten percent.” Tyler shook his head. “I can’t imagine how discouraging it must have been for Opa.”

Liesbeth viewed him quizzically. “Maarten never expected to save those children.”

“He didn’t?”

“He would have loved to have saved them all, of course,” she said with a small sigh. “But your grandfather was a realist. He committed his life to easing their pain, not prolonging their lives. He couldn’t bear to see a child suffer. And in those days, some children used to suffer horribly in their final days with cancer.”

“But Opa became a pioneer of leukemia treatment. Under his guidance, the Alfredson boasted the highest survival rate in the country.”

“Yes, of course. When Maarten saw that he could offer hope to these children . . . it changed everything. That was later, after he had already established his practice.”

Tyler smiled. “He’s still so revered, you know?”

Liesbeth’s eyes lit with a hint of pride, but she laughed it away. “Maarten always hated that.”

“Hated what?”

“The accolades. The attention. It embarrassed him. He never considered himself more special than anyone else at the hospital.” She shrugged. “Perhaps less so.”

“I can relate.”

Liesbeth pursed her lips. “This is so very unlike you, Tyler. You have always thrived on attention.”

He sipped the bitter, rich coffee. “There’s good attention, and then there’s the other kind.”

Liesbeth viewed her grandson silently.

“Something went very wrong at the hospital.”

Liesbeth waited.

“A boy that I treated for leukemia . . .,” he began.

Tyler had never discussed his work with his grandmother. He certainly had no intention of sharing the specifics of the Nate Stafford case, but once he started he could not stop himself. As he spoke, he realized how good it felt to unload to her. Liesbeth said nothing, but her forgiving eyes brought Tyler unexpected solace.

“I doubt Opa would have fumbled it as badly as I did,” he concluded.

She shook her head. “Tyler, you have no idea how much it all haunted him.”

“Liesbeth, his judgment was legendary. People still speak of him with awe.”

“
People
never know the whole truth, do they?”

“What was the truth?”

“Your Opa hardly slept. He took all kinds of sleeping pills. It didn’t help much. If ever Maarten did fall asleep, most nights he woke in a cold sweat.” She shook her head again. “The nightmares . . .”

Tyler shook his head. “I always just thought of him as a grandfather—the best one a boy could have—but I had no idea just how important a doctor he was until I started medical school.”

Liesbeth shifted in her seat. A vaguely uncomfortable look flitted across her face but then was gone. “Listen, Tyler, do you know how Maarten came to America?”

“You came together from The Hague right after the war, didn’t you?”

She shook her head. “Maarten was eight years older. We did not know each other in Holland. I came to Seattle in 1946, to live with my aunt and uncle. I met Maarten here, not in Europe.” She paused. “He came before me. As a war refugee.”

“A refugee?”

“Maarten was Jewish.”

“You’re kidding!” Evan sputtered. “ ‘Vanderhof’ doesn’t sound Jewish.”

“It isn’t. He changed it from Hertzog. He didn’t want people to know.”

“Why not?”

“A young Jew from occupied Holland . . .”

Tyler stiffened in his seat. “Wait a minute. Was Opa in the camps?”

Liesbeth nodded.

“Which one?”

She hesitated a moment. “Auschwitz.”

“
Auschwitz
,” he echoed, mouth agape.

She lowered her voice and glanced over her shoulder as if to ensure no one was listening. “His parents and his brother and sister were all slaughtered there. Maarten spent eighteen months in that hell. Can you imagine?”

His mouth went dry. “I can’t even begin to.”

“After what he lived through . . . what he saw . . . Maarten wanted no part of religion. And he was so ashamed.”

“Why ashamed?” Tyler threw his hands in the air. “Opa was a victim.”

“Ashamed of surviving, when so many didn’t.” Liesbeth smiled distantly. “Maarten never set out to hide his Jewish heritage. Just Auschwitz. He never wanted to discuss his experience or what had happened to his family. To that end, he found it easier not to tell people he was Jewish.”

Tyler was still digesting the news of his Jewish roots and tragic family secret when his belt vibrated. Distractedly, he reached down and grabbed for his pager. He glanced at the screen. The phone number for the SFU appeared with the numbers “911” added afterward.

He hopped to his feet. “Liesbeth, there’s an emergency on the ward.”

“Go, go,” she said, unfazed by the abrupt interruption like the consummate doctor’s wife she had been.

Tyler leaned forward and kissed his grandmother on the cheek. “I want to hear more about this.”

“Next time.”

Tyler turned for the door. He squeezed his cell phone between his shoulder and his ear as he hurried out to his car. The SFU’s receptionist told him that one of his patients, Paige Newcomb, had developed “a major allergy” but she knew few details, only that the nurses told her to page him “stat” and the girl “was going down the tube.”

As Tyler raced into the hospital, he thought about the anxious teenager with leukemia who had been more worried about the cosmetic impact of her rash and impending baldness than her cancer. Little had gone right for Paige since her admission. Her allergies to the chemotherapy drugs continued to worsen. Tyler had changed her treatment protocol three times and premedicated her with numerous drugs to try to prevent the allergic reactions but nothing seemed to help.

His car screeched into the Alfredson parking garage seven minutes after
leaving Le Bistro. Abandoning his car in one of the emergency on-call parking spaces, he ran down the stairs and along the tunnel leading to the children’s hospital. By the time he reached the SFU, the main corridor was deserted. In front of Paige Newcomb’s room, he spotted a cart loaded with equipment and machinery and recognized it, ominously, as the “crash cart” or mobile resuscitation unit.

Heart in his throat, he sprinted down the hallway.

The room was packed. Respiratory therapists, lab technicians, and nurses milled around the room, some purposefully, others just watching. Few words were spoken, but the air was electrified. Tyler spotted Nikki Salazar at the far side of the bed, adjusting the flow rate on an intravenous bag. Their eyes locked for a moment. Something seemed different about her, but Tyler didn’t have a moment to even consider what might have accounted for the change. Her quick nod conveyed the gravity of the situation better than words.

Dr. Randall Gratton, the baby-faced senior resident, stood above the head of the bed, his complexion blotchy and brow sweaty. He was holding a triangular mask to Paige’s face, fiercely pumping oxygen into her mouth with the attached Ambu bag.

Tyler wove hurriedly through the crowd to reach the bedside. “What have you got, Randall?”

Gratton glanced over at him without slowing the rhythm of his pumping hand. “Worst allergic reaction I’ve ever seen. Broke out right after her
A.M
. dose of chemo,” he said in a grim but calm voice. “Her blood pressure has dropped to nothing from the anaphylaxis.” He used the term for critical allergic shock. “And look at this angioedema.”

Gratton lifted the mask from Paige’s mouth to reveal her face. Tyler was shocked by the distorted anatomy. Her normally thin neck and face were so swollen that he wasn’t clear where one ended and the other began. Her frightened eyes bulged out of their sockets from swelling. Her lips were so puffed up that they resembled two grotesque pink slugs. The end of her ballooning tongue protruded between them.

Tyler reached down and squeezed Paige’s shoulder. He looked into her panicky eyes. “We’re going to make this better, Paige,” he said, hoping the promise wasn’t an empty one.

Gratton eyed him doubtfully. “I can barely pump oxygen into her with
the bag,” he said, speaking in a quiet, urgent tone. “There’s no way I can stick a tube down her airway through this much swelling.”

The young doctor was right. Paige’s airway anatomy must have been as distorted as her face. “Have you notified ENT and Anesthesia?” Tyler asked.

Gratton wiped his brow with his forearm and nodded. “They’re on their way.”

“Good.” Tyler knew that even the best anesthesiologist or ear, nose, and throat surgeon might not be able to establish an airway, even with a tracheotomy, through so much swollen tissue. “What drugs have you given her?”

Gratton listed off the standard medications they had poured into Paige’s veins.

Sweat streaming under his arms, Tyler looked over and caught Nikki’s attention. “I want an epinephrine bolus of one milligram, followed by a steady infusion at thirty micrograms,” he said, calling for the heaviest artillery of antiallergy drug at a dose that had the potential to cause a cardiac arrest. It was a risk he would have to take. If her swelling worsened, Paige’s airway might close over, in which case she would suffocate in front of their eyes.

Gratton gaped at him questioningly. With a crisp nod, Nikki reached for a syringe, plugged it directly into the intravenous tubing, and squeezed the plunger down.

“Give her forty milligrams of dexamethasone,” Tyler added, realizing that he was exceeding the maximum dose of the steroid. “And I want her to have two more liters of fluid, stat.”

Within seconds after Paige received the drugs, her eyes clouded over and slowly rolled upward in their sockets. The young nurse holding her wrist snapped, “I’ve lost her pulse!”

Not again!

Tyler’s eyes darted to the monitor, which showed a rapid heart tracing. His hand shot up to Paige’s neck to feel for a carotid pulse. He had to run his fingers up and down the swollen mass of tissue before he finally detected the faintest sensation.

The same nurse who had sounded the alarm was now leaning over Paige’s chest with her interlocking hands pressing down on her breastbone, poised to begin cardiopulmonary resuscitation.

“Stop!” Tyler barked. “She still has a pulse.” He swiveled his head to look at Nikki. “Give her another milligram of epinephrine.”

“It’s too soon, Tyler,” Gratton cried.

Nikki wavered.

“There’s no other option,” Tyler said with an encouraging nod.

The doubt left Nikki’s eyes as she plugged another syringeful of epinephrine into the intravenous tubing. She squirted it into the line without hesitation.

Gratton struggled harder than ever to force air into Paige’s mouth. Tyler reached down with both hands and dug his fingertips into the engorged folds of skin at the angles of the patient’s jaw. He yanked up and forward.

“Better!” Gratton grunted, able to squeeze larger volumes of oxygen into Paige’s mouth.

Tyler tasted salt, as more sweat dripped into his eyes.
Hang in there, Paige
. . .

Nikki reached a slender hand up to Paige’s bloated neck. Two of her fingers came to rest against the skin. “The pulse is strong,” she said.

No sooner had she spoken the words when Paige’s eyelids fluttered open. Her glassy eyes peered up at Tyler, still brimming with helpless anxiety.

Tyler forced a smile for her. “Paige, you’ve turned the corner,” he said.