The Doctor and Mr. Dylan (23 page)

“You did this to her. You screwed up the anesthesia in some way, to get rid of her.”

“Johnny, don’t say that to your father,” Echo said. She held her palm out toward Johnny in a halting gesture. Her fingers shook like tree branches in a storm.

“You don’t know them, Echo,” Johnny said. “You don’t know how they fight. You don’t know much they hate each other. But what about me? Dad, how could you do this to me?”

“I didn’t do anything to you. I promise we’ll make every effort to help her get better. I’ll come and talk to you as soon as we know more. I promise.”

Echo and I resumed pushing the bed toward the brain scanner. As we rolled Alexandra’s bed into the elevator, Johnny stared at us. The elevator door closed, and the three people Johnny cared most about disappeared behind panels of sliding steel.

One hour later I met with Dr. Mattson outside the Intensive Care Unit. Alexandra’s clinical condition was unchanged. We stood over her body in a private ICU room, where her breathing was supported by the monotonous cadence of a mechanical ventilator. The neurologist crossed his arms and pushed his lips into a pout. His expression freaked me out. The news couldn’t be good.

“What did the scan show?” I said.

Mattson raised one eyebrow. “The preliminary report on the scan is normal.”

“That’s good news.”

“It is. The scan tells us there is no intracerebral bleed, no obvious stroke, and no discernable pathology. The scan gives us no explanation for her coma. I’m puzzled, as I’m sure you are, too.”

Mattson’s cell phone rang. He took the call, and his expression grew more and more serious as he listened. He hung up, bit against his lower lip, and squared himself to me. “That was the director of the clinical laboratory, telephoning me with Mrs. Antone’s lab results. I have some very bad news for you, Dr. Antone.”

“What kind of bad news?” I said, my voice reduced to a hoarse croak.

“Your wife’s glucose concentration is the lowest the lab director’s ever seen,” Dr. Mattson said. “Her blood sugar is 2 mg/dL.”

“Two? How could it be two?”

“I don’t know. We’ll need to draw a second sample and recheck it to confirm the hypoglycemia. The normal range for glucose is 60–100 mg/dL. If her blood level is truly 2, then I’m afraid that her low blood sugar explains her coma.”

“We need to give her some intravenous dextrose. We need to draw another glucose level, stat, and then inject two amps of D 50. Get me a syringe.” I wrapped a tourniquet around her left arm and located the cephalic vein at the crook of her elbow. The ICU nurse handed me an empty syringe, and I drew out a sample of Alexandra’s blood to send to the lab. The nurse handed me two ampoules of 50% dextrose, and I injected the sugar into her IV as fast and as hard as a man could push.

We watched and waited.

The digital clock on the wall flipped to the next minute and then the next, as we stood vigil over Alexandra’s motionless flesh. After five minutes, there was no change. I ground my knuckles into Alexandra’s hard breastbone and said, “Alex, wake up! Can you hear me? For God’s sakes, wake up!”

Nothing changed. The quiet in the room was haunting. Only the periodic purring of the ventilator broke the hush. “What do we do now?” I whispered to Dr. Mattson.

“She’s been comatose since the surgery ended. That was three hours ago. If hypoglycemia was the cause of this coma, and it’s almost certain that it was, then her brain has been deprived of sugar for a prolonged period of time. The damage is sure to be irreversible.”

I leaned back on the wall and slid downward, a blob melting into the floor. I buried my face in my hands and screamed a loud “Nooooo” that bounced off the walls of the tiny ICU room and echoed into the ears of every human in that half of the hospital. Dr. Mattson laid his hand on my shoulder and tried to console me, but I was in a universe all to myself—a world of hurt, despair, and stigma. On my shift, on my watch, my wife had incurred the greatest loss a human could sustain. Brain cells died without glucose. Once they were dead, they never came back.

Mattson said, “I wish there was something I could do to make the situation better. I can’t imagine how you must feel. The next step in my work-up is to order an EEG. Depending on the results of the electroencephalogram, we will decide what to do next.”

I peeled my hands away from my face. Between hyperventilating gasps I asked the obvious question. “How did her blood sugar get so low?”

“I don’t know. I’m going to contact my colleagues at the University of Minnesota and the Mayo Clinic for their opinions.”

“I need to talk to my son before everybody in town finds out what just happened to his mom. He needs to hear this from me.”

“Of course.”

I stood, surprised that my wobbly legs supported me at all. I dreaded the confrontation with Johnny. I trudged back toward the O.R. with the sensation of a steel band encircling my chest. The effort required to inhale a single breath was overwhelming.

I found Johnny in the O.R. hallway. He was circling, a hamster bouncing off the bars of his cage. He planted his fists on his hips and said, “What’s the deal? Is Mom going to be all right?”

The tone of his voice, his resentment and his scorn were too familiar—the reincarnation of Alexandra. My teenager son, who’d been in love with Minnesota, Echo, and life, had turned into a younger, male version of his mother.

I gave it to him straight. “Son, they did some tests, and they were all normal except for one: Your mother’s blood sugar was very, very low.”

“What does that mean?”

“That means her brain took a hit. She might not wake up.”

“Not wake up? You said this was a really common surgery. You said it was going to be routine.”

“It was.”

“How could her blood sugar get so low?”

“I don’t know. No one knows. The neurologist is calling the U of M and the Mayo Clinic for their expertise.”

“You bumped her off. While she was under anesthesia, you bumped her off. What other explanation is there? Do you think people up here are so stupid they won’t figure that out? I’m 17, and I figured it out.” He laid his hands on my chest, and shoved me out of the way. “I’m going to the ICU. I need to see her.”

“Johnny…”

“Leave me alone,” He turned on me, and ran down the corridor toward the elevator.

Alexandra was dead, and Johnny was gone.

Every atom in my body was spinning out of control. I had no idea I could feel this awful. I staggered down the hallway until I found a vacant men’s restroom. I locked myself inside, dropped to my knees on the cold tile floor, folded my hands, and prayed for the first time since grade school.

I didn’t pray for Alexandra. Alexandra’s ship had sailed into the sunset. I prayed for myself.

CHAPTER 19

TANGLED UP IN INSULIN

Dr. Roger Olson, the Chief Executive Officer of Hibbing General Hospital, sat at a small metal desk cluttered with papers. Snow blew in diagonal lines through barren branches outside the window behind him, a mobile collage framing the grim-faced Olson. Olson clamped his eyes shut in an involuntary spasm every twenty seconds or so. Between blinks, he focused his Norwegian eyes at me and said, “I have additional bad news regarding your wife’s case, Dr. Antone.”

“Hit me. It can’t get any worse.”

“Her EEG shows that she is indeed brain dead. But the most troubling findings are the results of insulin levels.”

“Insulin levels?”

“Yes. Her blood insulin levels are extremely high—the highest our lab has ever seen.”

“Why are the insulin levels so high?”

“I don’t know, but the working diagnosis is exogenous insulin.”

“Exogenous insulin?”

“Correct.” Dr. Olson stared me down. His eyelids squeezed over and over, accelerating, pumping like window blinds closing and opening. Between blinks, his sapphire irises bore down on me with horrible accusing power. “It appears that Mrs. Antone received a massive overdose of insulin.”

“That’s not possible. There was no insulin in the operating room. I’m not stupid. I would never have done that.”

“I’m not making any judgment calls, Dr. Antone, but I’d suggest you report this to your malpractice insurance company as soon as possible. And from my experience with the medical-legal system, I’d recommend that you don’t discuss the sensitive medical details with anyone until you’ve met with a lawyer.”

I slammed both palms down on Olson’s desk and said, “I’m no fool. I did not inject insulin into my wife during anesthesia. I can’t believe you just accused me of that.”

“I didn’t accuse you of anything. I just revealed the facts of the case to you, and I’m telling you: get a lawyer.”

“I’m innocent.”

“I hope there’s an alternative explanation, Dr. Antone. I must tell you, though, that the word going around the hospital is that you and your wife were not on good terms. The word going around is that she cheated on you, and that you despised her. People are speculating that you had a motive to do this to Alexandra—to get rid of her.”

“And lose my medical license and maybe even go to jail? Are you kidding me? I’ll say it again: I’m not stupid. If I did this, I’d be certain to be caught. Where would that leave me? I’d never dare such folly. You’ve got to help me.”

“We’ll go over every nuance of Mrs. Antone’s medical care with a microscopic eye to detail.” The eyelids squeezed down hard, vise grips tightening. “The coroner will conduct an autopsy. Our peer review and quality assurance people will gather data. Be reassured, this is no witch-hunt. Our job is to discern the facts.”

“The fact is I did nothing to harm Alexandra.”

Olson raised one eyebrow. “I want to believe that, Dr. Antone. Really I do.” He closed the folder that contained Alexandra’s test results, folded his hands over it, and said, “Good day, Dr. Antone.”

I made a return visit to my wife’s bedside in the ICU, where I came face-to-face with the last person I ever expected to see in Hibbing. Beard Man, Alexandra’s lover from California, sat perched on the edge of her bed. I watched as he stroked the skin of Alexandra’s forearm and whispered into her ear. I was stunned. Our first meeting was one of the ugliest ordeals of my life. The circumstances of this second meeting were even worse. After all these years of marriage to Alexandra, why should I have to share the deathbed vigil with her hirsute lover?

I paused in the doorway and considered whether a quick one-eighty was the correct maneuver. Before I could exit, Beard Man looked up and saw me. “You,” he said. He strode toward me with the predatory stride of a lion hunting food. Despite the modest fluorescent lighting of the intensive care room, the man wore sunglasses. A demonic beard tapered to a precise point under his chin. His hands drooped impossibly low, below his knees. He was a Neanderthal Satan in shades. Beard Man planted his right forefinger firmly against my chest and said, “You had to get even, didn’t you? Did you think you wouldn’t get caught?”

“I know it looks bad, but…”

“You’re going down. I’ve already talked to the Medical Board of Minnesota and to the prosecuting district attorney for this county. They’re coming after you. I’m coming after you. You’re going to burn for this.”

I peeled the accusing finger off my chest and pondered how to respond to the accusations. Before I could speak, there was a commotion behind me, and five young men dressed in white coats and blue surgical scrubs entered Alexandra’s room. The lead man strode to the bedside, the clacking heels of his cowboy boots announcing that he was from out of town. A
University of Minnesota Hospitals and Clinics
nametag hung from his lapel. He extended his hand to me and said, “I’m Dr. Leroy McLean, cardiothoracic surgery, from the organ procurement team at the U. I need to speak to the Alexandra Antone’s next of kin.”

“I’m her husband,” I said, a sick feeling mounting in my stomach.

“Your wife was signed up as a donor. We’re here to harvest the organs, as soon as the coroner gives us clearance to proceed. This is the rest of my team: Dr. Harvey Olds and Dr. Samuel Ponds of surgery, Dr. Mike Giamotti of anesthesia, and Robert Gossamer, the lead transplant nurse.” The four men looked past me at the horizontal figure of Alexandra, a brain-dead fertile garden of useful tissues. They were sizing up their task, planning their next moves.

“Now? You guys are going to cut her up now?” Beard Man said.

“Who are you?” Dr. McLean said.

“I’m Frank Demitree, a close friend of Alexandra’s.”

“Mr. Demitree, our team is trained to extract the organs and tissues an individual has consented to donate. In Ms. Antone’s case, her list included the heart, lungs, liver, kidneys, corneas, and Achilles tendons. The harvest procedure will be done in an operating room at this hospital. The vital organs will be transported back to Minneapolis via fixed wing transport as soon as we’re finished.”

“But after you do that, she’ll be a carcass with an empty chest. She’ll never come back.”

“Mr. Demitree, I can assure you that Alexandra Antone has already been declared brain dead, and that she’s never coming back. Removing a beating heart may seem like a fatal move, but in her case, it is a life-affirming move that will give years of survival to an individual with a failing heart. “