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Spring in Charleston, South Carolina, is a resplendent affair, and by the beginning of April, it is always well underway. As if competing for attention, the azaleas, the camellias, the hyacinths, the early blooming magnolias, and the forsythias all contribute their riot of color and fragrance. And on this particular day, as the sun prepared to rise there was the promise that it would be glorious day for most everyone in this scenic, historic town. Everyone, that is, except Carl Vandermeer, a successful, young lawyer who had grown up in nearby West Ashley.
Most mornings, regardless of the time of the year but particularly in the springtime, Carl would be part of a sizable group of joggers who ran along the Battery that was located at the southern tip of Charleston’s peninsula. The Battery fronted that portion of the expansive Charleston Harbor formed by the confluence of the Cooper and the Ashley River. Lined with period mansions and boasting a public garden, the Battery was one of the most attractive and popular locales of the city.
Like most of the other runners, Carl lived in the surrounding and charming residential neighborhood called SOB to the locals as the acronym for ‘South of Broad Street.’ Broad Street was a thoroughfare that ran east-west across the Charlestown peninsula between the two rivers.
The reason Carl was not jogging this beautiful, spring morning was the same reason he had not been jogging for the previous month. He had torn his anterior-cruciate ligament in his right knee during the final basketball game of the past season. He and a half dozen other athletically inclined lawyers had formed a team to play in a city league.
Carl had always been into sports through high school and Duke University where he played Division 1 lacrosse with considerable renown. Having made it a point to keep himself in shape even during law school, he thought of himself as generally immune to injury, especially since he was only twenty-nine years old. Throughout his athletic career he had never suffered more than a couple of sprained ankles.
So the knee injury had come as an unwelcome surprise. One minute he was perfectly fine having played the entire first half of the game and scored eighteen points in the process. With the ball in his possession, he had faked the fellow guarding him to the left and then went to the right to drive to the basket. He never made it. The next thing he knew he was sprawled on the floor unsure of how he had gotten there. Embarrassed, he got right to his feet. There was some discomfort in his right knee, but it wasn’t bad. He took a few steps to walk it out and immediately collapsed for the second time. That was when he knew it was serious.
A visit to Dr. Gordon Weaver, an orthopedic surgeon, had confirmed the diagnosis as a torn anterior cruciate ligament. Even Carl, a complete medical novice by choice, had been able to see it on the MRI. The bad news was he’d have to have surgery if he wanted to play any kind of sports. Dr. Weaver said the best operation involved diverting a portion of his own patellar tendon up through his joint. The only good news was that his health plan would cover the whole deal including the rehab. His bosses at the law firm where he worked were not thrilled about the necessary down time, but missing work was not what bothered Carl. What bothered Carl was that he had a particularly strong distaste for having anything to do with medicine and needles. He had been known to pass out merely having blood drawn and didn’t even like the smell of rubbing alcohol because of its associations. He had never been hospitalized, but he had visited friends who had been and the experience had freaked him out so going into the hospital that morning for surgery was going to be a challenge to say the very least.
The irony of his embarrassing and secret medical phobia was that his steady girlfriend for the last two years, Lynn Peirce, was a fourth year medical student. She often made him lightheaded with her stories of her daily experiences at the Mason-Dixon Medical Center where Carl was scheduled to have his surgery in a few hours. It had been she who had recommended Dr. Weaver and had explained in agonizing detail on exactly how his knee was going to be repaired.
It also had been Lynn’s insistence that he request to have his operation be Dr. Weaver’s first case on a Monday morning, saying that everyone was fresh and there was less chance for mistakes. Carl knew that Lynn meant well through all this, but her comments only made him even more nervous.
Lynn had offered to spend the night as she had Saturday night to make sure Carl followed his pre-op orders and got to the hospital on time, but Carl had begged off. He was afraid she might end up innocently saying something that would make him even more nervous than he already was. But he didn’t tell her that. He said he thought he’d sleep better alone and reassured her that he would follow his pre-op instructions to the letter. She had accepted gracefully and said that she’d come and visit him in his hospital room as soon as he came back from the PACU or post-anesthesia care unit.
Carl had never mentioned his medical-phobia to Lynn for fear that she, at a minimum, would laugh at him. Nor did he let on how anxious he was about his up-coming surgery. For ego preservation, there were some things that were better left unsaid.
Carl let the alarm ring unabated for a time for fear of falling back asleep. He’d slept poorly and had trouble getting to sleep the night before. His instructions from Dr. Weaver’s nurse were not to eat after midnight except water and take a good, hot shower with antimicrobial soap when he got up, paying particular attention to his right leg. He was supposed to arrive at the hospital no later than seven, which was going to be a rush since it was already six-thirty. He wanted it to be a rush, thinking he’d have less chance to think, but here he was not even out of bed and already anxious.
As if sensing his distress, Pep, his nimble eight-year-old Burmese cat, awoke at the foot of the bed and came up to rub her wet nose against Carl’s stubbled chin.
“Thank you, girl,” Carl said, tossing back the covers and making a beeline into the bathroom. Pep tagged along as always. Carl had saved the cat at the end of his undergraduate senior year at Duke when one of his classmates was going to abandon the feline at the pound after graduation with hopes it would be adopted. Carl couldn’t abide by the plan, thinking it a possible death sentence. He took the cat home for the summer, got hopelessly enamored and ended up taking it to law school with him. Frank Giordano, a close friend and fellow basketball-playing lawyer, who was going to be arriving shortly to drive Carl to the hospital, had volunteered to take care of the cat by coming to Carl’s house and making sure it had food and water until Carl’s homecoming in three days. Everything was in order or so Carl thought.
*
As Carl Vandermeer eased into a hot shower, Dr. Sandra Wykoff leapt out of her BMW X3.She was in a hurry because she loved her work. In contrast to Carl Vandermeer, she loved medicine so much she had not taken a real vacation in the three years she’d been on staff of the Mason-Dixon Medical Center. She was a board certified anesthesiologist who had trained across town at the older Medical University of South Carolina. She was thirty-five years old, a workaholic, and relatively recently divorced after a short marriage to a surgeon.
From her reserved parking spot on the first floor of the parking garage, she eschewed the elevator and took the stairs. It was only one flight, and she liked exercise. The state-of-the-art operating rooms of the medical center, which was built just after the millennium, were on the second floor. In the surgical lounge she gazed up at the monitor displaying the image of the operating room’s white board. She was assigned to OR12 for four cases, the first being a right anterior cruciate repair with a patellar allograph by Gordon Weaver under general anesthesia. She was pleased. She particularly liked Gordon Weaver. Like most of the orthopedic guys he was a gregarious fellow who enjoyed his work. Most importantly from Sandra’s perspective, he didn’t dawdle and was vocal if there were more blood loss than expected. To her, such communication was important, but not every surgeon was as cooperative. Like all anesthesiologists, she knew that it was she who was responsible for the patient’s well-being during an operation, not the surgeon, and she appreciated being informed if anything out of the ordinary occurred.
Using her tablet PC Sandra typed in the patient’s name, Carl Vandermeer, along with his hospital number and her PIN to access his nascent EHR, electronic health record. She wanted to look at his pre-op history. A moment later she knew what she was dealing with: a healthy, twenty-nine year old male with no drug allergies and no previous anesthesia. In fact there had been no previous hospitalizations for any reason whatsoever. It was going to be an easy, straight forward case, or so she thought.
After changing into her scrubs, she made her way into the OR proper, passing the OR desk commanded by the extraordinarily competent OR supervisor, Geraldine Montgomery. Continuing on, she passed the entrance to the PACU on her right, which used to be called the recovery room. The preoperative holding area was on the left. There was a lot of frenetic activity in both rooms. A bevy of nurses and orderlies were preparing for the inevitably busy Monday schedule.
As a generally friendly although private person, Sandra greeted anyone who caught her eye, but she didn’t stop to talk or even slow down. She was on her usual early morning mission. She was eager to check out the anesthesia machine she would be using for the day, something all anesthesiologists and nurse anesthetists were required to do. The difference was that Sandra was more conscientious than most and couldn’t wait to start.
Sandra worshipped the newer anesthesia machine that was essentially computer driven. In fact it was the expanding role that the computer played in anesthesia that had attracted her to the specialty in the first place. As her father’s daughter, Sandra was also attracted to most everything mechanical. Her father, Steven Wykoff, was an automotive engineer brought to Spartanburg, South Carolina, from Detroit, Michigan, by BMW in 1993. The fact that computers were destined to become more and more involved in medicine was the reason she went to medical school. It was during her third year surgery rotation that she was introduced to anesthesia, and she was captivated from the start. The specialty was a perfect blend of physiology, pharmacology, computers, and mechanical devices.
Entering OR twelve, Sandra greeted Claire Beauregard, the assigned circulating nurse, who was already busy setting up for the case. But there was no conversation. Sandra made a beeline to her trusted mechanical partner with which she was going to be spending most of the day. It bristled with varying colored cylinders of gas, multiple monitors, meters, gauges, and valves. The machine, like all the equipment in the relatively new hospital complex, was a state of the art computer controlled model. It was number #37 out of nearly a hundred total. The number was on a sticker on the machine’s side, which also included its service history.
From Sandra’s perspective the apparatus in front of her was a marvel of engineering. Among its many features was an automatic checklist function that satisfied what the FDA required before use, akin in many respects to the required checklist used in a modern aircraft before takeoff to make certain all systems function properly. But Sandra did not turn the machine on immediately to initiate the automatic checklist. She liked to check the machine the old fashioned way, particularly the high-pressure and the low-pressure systems, just to be one hundred percent certain everything was in order. She liked to physically touch and operate all the valves. It made her much more confident than relying on a computer controlled algorithm.
Satisfied with what she found, Sandra rolled over the stool that would be her perch for the day, sat down, and pulled herself directly up to the anesthesia machine’s front. Only then did she turn the machine on. Spellbound as usual, her eyes stayed glued to the monitor as the apparatus went through its own automated checklist, which included most of what she had already done. A few minutes later the machine indicated all was in order, including the alarms for trouble such as changes in the patient’s blood pressure, heart function, or low oxygen levels in the blood.
Sandra was pleased. When there was something amiss, even a minor thing, she was obliged to contact the Clinical Engineering Department, which serviced the anesthesia machines. She found the technicians to be a weird bunch. Those she had had interaction with were all expat Russians with varying fluency in English most of whom seemed like the teenage computer nerds of her youth. She particularly did not like Misha Zotov who had sought her out in the hospital cafeteria after she’d gone down to the department to ask a simple service related question. He gave her the creeps particularly after he called her at home to ask her to have a drink with him. How he’d gotten her unlisted number she had no idea. Her response was to fib and say she was in a committed relationship.
Sandra then began checking her supplies and pharmaceuticals with equal diligence. She liked to touch everything she might need so she knew where it was. If there was an emergency she didn’t want to search for anything. She wanted everything at her fingertips.
*
“Want me to park and come in with you?” Frank Giordano asked Carl as he turned into the Mason-Dixon Medical Center a few minutes after seven. They had been driving in silence. Initially Frank had tried to make conversation as they started northward up King Street, but Carl wasn’t holding up his side. Frank guessed that Carl was stressed out about his upcoming surgery, especially after Carl admitted he was as nervous as hell before they had started out.
“Thanks, but no,” Carl said. “I’m a little late which I hope means I’m not going to be sitting around.” It was clear he was agitated.
“Hey, man,” Frank said. “You got to relax! It’s no big deal. I had my tonsils out when I was ten. It was a piece of cake. I reme...
Présentation de l'éditeur :
Most mornings, regardless of the time of the year but particularly in the springtime, Carl would be part of a sizable group of joggers who ran along the Battery that was located at the southern tip of Charleston’s peninsula. The Battery fronted that portion of the expansive Charleston Harbor formed by the confluence of the Cooper and the Ashley River. Lined with period mansions and boasting a public garden, the Battery was one of the most attractive and popular locales of the city.
Like most of the other runners, Carl lived in the surrounding and charming residential neighborhood called SOB to the locals as the acronym for ‘South of Broad Street.’ Broad Street was a thoroughfare that ran east-west across the Charlestown peninsula between the two rivers.
The reason Carl was not jogging this beautiful, spring morning was the same reason he had not been jogging for the previous month. He had torn his anterior-cruciate ligament in his right knee during the final basketball game of the past season. He and a half dozen other athletically inclined lawyers had formed a team to play in a city league.
Carl had always been into sports through high school and Duke University where he played Division 1 lacrosse with considerable renown. Having made it a point to keep himself in shape even during law school, he thought of himself as generally immune to injury, especially since he was only twenty-nine years old. Throughout his athletic career he had never suffered more than a couple of sprained ankles.
So the knee injury had come as an unwelcome surprise. One minute he was perfectly fine having played the entire first half of the game and scored eighteen points in the process. With the ball in his possession, he had faked the fellow guarding him to the left and then went to the right to drive to the basket. He never made it. The next thing he knew he was sprawled on the floor unsure of how he had gotten there. Embarrassed, he got right to his feet. There was some discomfort in his right knee, but it wasn’t bad. He took a few steps to walk it out and immediately collapsed for the second time. That was when he knew it was serious.
A visit to Dr. Gordon Weaver, an orthopedic surgeon, had confirmed the diagnosis as a torn anterior cruciate ligament. Even Carl, a complete medical novice by choice, had been able to see it on the MRI. The bad news was he’d have to have surgery if he wanted to play any kind of sports. Dr. Weaver said the best operation involved diverting a portion of his own patellar tendon up through his joint. The only good news was that his health plan would cover the whole deal including the rehab. His bosses at the law firm where he worked were not thrilled about the necessary down time, but missing work was not what bothered Carl. What bothered Carl was that he had a particularly strong distaste for having anything to do with medicine and needles. He had been known to pass out merely having blood drawn and didn’t even like the smell of rubbing alcohol because of its associations. He had never been hospitalized, but he had visited friends who had been and the experience had freaked him out so going into the hospital that morning for surgery was going to be a challenge to say the very least.
The irony of his embarrassing and secret medical phobia was that his steady girlfriend for the last two years, Lynn Peirce, was a fourth year medical student. She often made him lightheaded with her stories of her daily experiences at the Mason-Dixon Medical Center where Carl was scheduled to have his surgery in a few hours. It had been she who had recommended Dr. Weaver and had explained in agonizing detail on exactly how his knee was going to be repaired.
It also had been Lynn’s insistence that he request to have his operation be Dr. Weaver’s first case on a Monday morning, saying that everyone was fresh and there was less chance for mistakes. Carl knew that Lynn meant well through all this, but her comments only made him even more nervous.
Lynn had offered to spend the night as she had Saturday night to make sure Carl followed his pre-op orders and got to the hospital on time, but Carl had begged off. He was afraid she might end up innocently saying something that would make him even more nervous than he already was. But he didn’t tell her that. He said he thought he’d sleep better alone and reassured her that he would follow his pre-op instructions to the letter. She had accepted gracefully and said that she’d come and visit him in his hospital room as soon as he came back from the PACU or post-anesthesia care unit.
Carl had never mentioned his medical-phobia to Lynn for fear that she, at a minimum, would laugh at him. Nor did he let on how anxious he was about his up-coming surgery. For ego preservation, there were some things that were better left unsaid.
Carl let the alarm ring unabated for a time for fear of falling back asleep. He’d slept poorly and had trouble getting to sleep the night before. His instructions from Dr. Weaver’s nurse were not to eat after midnight except water and take a good, hot shower with antimicrobial soap when he got up, paying particular attention to his right leg. He was supposed to arrive at the hospital no later than seven, which was going to be a rush since it was already six-thirty. He wanted it to be a rush, thinking he’d have less chance to think, but here he was not even out of bed and already anxious.
As if sensing his distress, Pep, his nimble eight-year-old Burmese cat, awoke at the foot of the bed and came up to rub her wet nose against Carl’s stubbled chin.
“Thank you, girl,” Carl said, tossing back the covers and making a beeline into the bathroom. Pep tagged along as always. Carl had saved the cat at the end of his undergraduate senior year at Duke when one of his classmates was going to abandon the feline at the pound after graduation with hopes it would be adopted. Carl couldn’t abide by the plan, thinking it a possible death sentence. He took the cat home for the summer, got hopelessly enamored and ended up taking it to law school with him. Frank Giordano, a close friend and fellow basketball-playing lawyer, who was going to be arriving shortly to drive Carl to the hospital, had volunteered to take care of the cat by coming to Carl’s house and making sure it had food and water until Carl’s homecoming in three days. Everything was in order or so Carl thought.
*
As Carl Vandermeer eased into a hot shower, Dr. Sandra Wykoff leapt out of her BMW X3.She was in a hurry because she loved her work. In contrast to Carl Vandermeer, she loved medicine so much she had not taken a real vacation in the three years she’d been on staff of the Mason-Dixon Medical Center. She was a board certified anesthesiologist who had trained across town at the older Medical University of South Carolina. She was thirty-five years old, a workaholic, and relatively recently divorced after a short marriage to a surgeon.
From her reserved parking spot on the first floor of the parking garage, she eschewed the elevator and took the stairs. It was only one flight, and she liked exercise. The state-of-the-art operating rooms of the medical center, which was built just after the millennium, were on the second floor. In the surgical lounge she gazed up at the monitor displaying the image of the operating room’s white board. She was assigned to OR12 for four cases, the first being a right anterior cruciate repair with a patellar allograph by Gordon Weaver under general anesthesia. She was pleased. She particularly liked Gordon Weaver. Like most of the orthopedic guys he was a gregarious fellow who enjoyed his work. Most importantly from Sandra’s perspective, he didn’t dawdle and was vocal if there were more blood loss than expected. To her, such communication was important, but not every surgeon was as cooperative. Like all anesthesiologists, she knew that it was she who was responsible for the patient’s well-being during an operation, not the surgeon, and she appreciated being informed if anything out of the ordinary occurred.
Using her tablet PC Sandra typed in the patient’s name, Carl Vandermeer, along with his hospital number and her PIN to access his nascent EHR, electronic health record. She wanted to look at his pre-op history. A moment later she knew what she was dealing with: a healthy, twenty-nine year old male with no drug allergies and no previous anesthesia. In fact there had been no previous hospitalizations for any reason whatsoever. It was going to be an easy, straight forward case, or so she thought.
After changing into her scrubs, she made her way into the OR proper, passing the OR desk commanded by the extraordinarily competent OR supervisor, Geraldine Montgomery. Continuing on, she passed the entrance to the PACU on her right, which used to be called the recovery room. The preoperative holding area was on the left. There was a lot of frenetic activity in both rooms. A bevy of nurses and orderlies were preparing for the inevitably busy Monday schedule.
As a generally friendly although private person, Sandra greeted anyone who caught her eye, but she didn’t stop to talk or even slow down. She was on her usual early morning mission. She was eager to check out the anesthesia machine she would be using for the day, something all anesthesiologists and nurse anesthetists were required to do. The difference was that Sandra was more conscientious than most and couldn’t wait to start.
Sandra worshipped the newer anesthesia machine that was essentially computer driven. In fact it was the expanding role that the computer played in anesthesia that had attracted her to the specialty in the first place. As her father’s daughter, Sandra was also attracted to most everything mechanical. Her father, Steven Wykoff, was an automotive engineer brought to Spartanburg, South Carolina, from Detroit, Michigan, by BMW in 1993. The fact that computers were destined to become more and more involved in medicine was the reason she went to medical school. It was during her third year surgery rotation that she was introduced to anesthesia, and she was captivated from the start. The specialty was a perfect blend of physiology, pharmacology, computers, and mechanical devices.
Entering OR twelve, Sandra greeted Claire Beauregard, the assigned circulating nurse, who was already busy setting up for the case. But there was no conversation. Sandra made a beeline to her trusted mechanical partner with which she was going to be spending most of the day. It bristled with varying colored cylinders of gas, multiple monitors, meters, gauges, and valves. The machine, like all the equipment in the relatively new hospital complex, was a state of the art computer controlled model. It was number #37 out of nearly a hundred total. The number was on a sticker on the machine’s side, which also included its service history.
From Sandra’s perspective the apparatus in front of her was a marvel of engineering. Among its many features was an automatic checklist function that satisfied what the FDA required before use, akin in many respects to the required checklist used in a modern aircraft before takeoff to make certain all systems function properly. But Sandra did not turn the machine on immediately to initiate the automatic checklist. She liked to check the machine the old fashioned way, particularly the high-pressure and the low-pressure systems, just to be one hundred percent certain everything was in order. She liked to physically touch and operate all the valves. It made her much more confident than relying on a computer controlled algorithm.
Satisfied with what she found, Sandra rolled over the stool that would be her perch for the day, sat down, and pulled herself directly up to the anesthesia machine’s front. Only then did she turn the machine on. Spellbound as usual, her eyes stayed glued to the monitor as the apparatus went through its own automated checklist, which included most of what she had already done. A few minutes later the machine indicated all was in order, including the alarms for trouble such as changes in the patient’s blood pressure, heart function, or low oxygen levels in the blood.
Sandra was pleased. When there was something amiss, even a minor thing, she was obliged to contact the Clinical Engineering Department, which serviced the anesthesia machines. She found the technicians to be a weird bunch. Those she had had interaction with were all expat Russians with varying fluency in English most of whom seemed like the teenage computer nerds of her youth. She particularly did not like Misha Zotov who had sought her out in the hospital cafeteria after she’d gone down to the department to ask a simple service related question. He gave her the creeps particularly after he called her at home to ask her to have a drink with him. How he’d gotten her unlisted number she had no idea. Her response was to fib and say she was in a committed relationship.
Sandra then began checking her supplies and pharmaceuticals with equal diligence. She liked to touch everything she might need so she knew where it was. If there was an emergency she didn’t want to search for anything. She wanted everything at her fingertips.
*
“Want me to park and come in with you?” Frank Giordano asked Carl as he turned into the Mason-Dixon Medical Center a few minutes after seven. They had been driving in silence. Initially Frank had tried to make conversation as they started northward up King Street, but Carl wasn’t holding up his side. Frank guessed that Carl was stressed out about his upcoming surgery, especially after Carl admitted he was as nervous as hell before they had started out.
“Thanks, but no,” Carl said. “I’m a little late which I hope means I’m not going to be sitting around.” It was clear he was agitated.
“Hey, man,” Frank said. “You got to relax! It’s no big deal. I had my tonsils out when I was ten. It was a piece of cake. I reme...
The explosive new thriller from New York Times–bestselling author and master of the medical thriller, Robin Cook.
Lynn Peirce, a fourth-year medical student at South Carolina’s Mason-Dixon University, thinks she has her life figured out. But when her otherwise healthy boyfriend, Carl, enters the hospital for routine surgery, her neatly ordered life is thrown into total chaos. Carl fails to return to consciousness after the procedure, and an MRI confirms brain death.
Devastated by Carl’s condition, Lynn searches for answers. Convinced there’s more to the story than what the authorities are willing to reveal, Lynn uses all her resources at Mason-Dixon—including her initially reluctant lab partner, Michael Pender—to hunt down evidence of medical error or malpractice.
What she uncovers, however, is far more disturbing. Hospitals associated with Middleton Healthcare, including the Mason-Dixon Medical Center, have unnervingly high rates of unexplained anesthetic complications and patients contracting serious and terminal illness in the wake of routine hospital admissions.
When Lynn and Michael begin to receive death threats, they know they’re into something bigger than either of them anticipated. They soon enter a desperate race against time for answers before shadowy forces behind Middleton Healthcare and their partner, Sidereal Pharmaceuticals, can put a stop to their efforts once and for all.
Lynn Peirce, a fourth-year medical student at South Carolina’s Mason-Dixon University, thinks she has her life figured out. But when her otherwise healthy boyfriend, Carl, enters the hospital for routine surgery, her neatly ordered life is thrown into total chaos. Carl fails to return to consciousness after the procedure, and an MRI confirms brain death.
Devastated by Carl’s condition, Lynn searches for answers. Convinced there’s more to the story than what the authorities are willing to reveal, Lynn uses all her resources at Mason-Dixon—including her initially reluctant lab partner, Michael Pender—to hunt down evidence of medical error or malpractice.
What she uncovers, however, is far more disturbing. Hospitals associated with Middleton Healthcare, including the Mason-Dixon Medical Center, have unnervingly high rates of unexplained anesthetic complications and patients contracting serious and terminal illness in the wake of routine hospital admissions.
When Lynn and Michael begin to receive death threats, they know they’re into something bigger than either of them anticipated. They soon enter a desperate race against time for answers before shadowy forces behind Middleton Healthcare and their partner, Sidereal Pharmaceuticals, can put a stop to their efforts once and for all.
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- ÉditeurPan Books
- Date d'édition2016
- ISBN 10 1509800727
- ISBN 13 9781509800728
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