I, Robot: To Protect Book 1, page 9
“So the reason for her heart failure is?”
Susan still shook her head.
“You know, Dr. Susan Calvin. Don’t you?”
Susan’s head finally stopped moving. She bit her lower lip. “I believe I do.”
Everyone else, including the cardiologists and her own attending, had dismissed her idea; but nothing else made sense. She wondered what Nate would think, especially in light of his reading those books. “The initial abnormality in her brain is called an arteriovenous fistula. In Starling’s case, it was congenital, meaning she had it at birth.”
Nate nodded his understanding.
“Normally, blood with oxygen in it flows from arteries to capillaries. The capillaries give the oxygen to all the tissues of our bodies, and the now-deoxygenated blood flows into the veins and goes back to the heart, then to the lungs, for more oxygen. With an A-V fistula, the blood flows right from an artery into a vein, bypassing the capillaries.”
Nate was clearly still following.
“Vein walls aren’t meant for the high-pressure flow of arteries, so the vein wall stretches. Blood pools in the stretched area, making it bigger. If it’s big enough, blood pressure falls. The heart has to pump harder to make up for it, and congestive heart failure can develop.”
“So,” Nate said carefully, “your concern is that the original A-V fistula wasn’t fixed properly.”
Susan cringed. Nate had summarized it perfectly. “And I, Psychiatry R-1 that I am, don’t see how I’m going to convince the greatest neurosurgeon in the world he made an enormous mistake.”
“Surgeons don’t have high opinions of the nonsurgical specialties.” It seemed more statement than question.
Susan could not forget her conversation with Kendall about that exact subject. “In general, that’s true. The more specialized the surgeon, the less he respects the medical specialties. Unfortunately, many of them consider psychiatry the lowest form of medicine. And, of course, R-1s are the lowest form of doctor.”
“Yet you are a doctor.”
“And obviously a fine diagnostician.”
Susan flushed. She had no idea how Nate would know such a thing. “I’m all right, but mostly unproven.” She returned to her original question. “So here’s my thing. If you were in my shoes, what would you do?”
Nate sucked air through his nose and let it slowly out his mouth. “In your position, I would have no choice but to act in Starling’s best interests.”
“Of course.” It was the job of physicians always to act in the best interest of any patient, regardless of age, situation, symptoms, or desires. “And it’s clearly in Starling’s best interests to find and treat the cause of her heart failure. The question is … how?”
Nate drummed his fingers on the end of the chair arm. “It seems to me you’re in a better position to answer that. Are you sure the cause is a botched surgery?”
Susan doubted anything in medicine was a certainty. “Reasonably sure. If it’s something else, it’s an amazing coincidence; but amazing coincidences do occur.”
“Can you prove it?”
Susan bit her lower lip in frustration. “I could, but not without doing tests I have no authority to order, ones that require a neurosurgeon’s approval. It would also take a skilled neurosurgeon to reopen the skull and take another look.”
“So … you need a neurosurgeon.”
“Yes.” Susan realized bringing in another neurosurgeon would cause more problems than facing the old one. She doubted any other neurosurgeon at Manhattan Hasbro would dare to second-guess Dr. Mandar’s proficiency and decisions, and they would want to know his opinion first. “Someone has to talk to Dr. Mandar about taking another look inside Starling.”
“Who indeed?” Though Nate spoke without emotion or accusation, Susan knew the answer. The cardiologists would only throw it back into her lap, and her attending refused to believe the great Sudhish Mandar could have made a mistake.
“Me,” Susan said meekly.
Nate only bobbed his head, more in thought than answer.
Susan glanced up at the clock. It read twelve thirty; she needed to get back to her patients. Sweeping the sandwich container into the bag with the rest of her uneaten lunch, she headed back toward the unit. “Wish me luck.”
“Luck,” Nate said, rising from his chair and heading back to his own work.
The unit phone felt like a lead weight in Susan Calvin’s hands as she punched in the Vox number for Dr. Sudhish Mandar and watched it enter the callback number. She considered using her own Vox but imagined she had a better chance of getting an answer if the neurosurgeon knew for certain the call originated from a number inside the hospital.
To Susan’s surprise, the callback came almost immediately. She picked up the receiver, her palms suddenly slippery. She felt as if someone had dried her mouth with a sponge and then shoved it, in a lump, down her throat. “Hello?”
A male voice in a thick, subcontinental Indian accent came through the receiver. “This is Dr. Mandar.”
Dr. Mandar himself. Susan had expected a resident or fellow, even a secretary or nurse to return the call for him. “This is Dr. Susan Calvin. I’m an R-1 on inpatient peds psychiatry. I have a patient —”
Anger tinged the voice. “You paged me during surgery!”
“What?” The word was startled from her.
“How dare you disturb the greatest neurosurgeon in the world in the middle of a procedure. I’ll have you know —”
Susan quailed, and her thoughts muddled. On her M-4 surgery rotations, the attendings and residents had always handed over their Vox to a nurse or unit clerk while they scrubbed. In her experience, surgeons never answered their own calls while performing an operation.
Dr. Mandar’s voice got louder, shriller, and ever more enraged. “The tiniest interruption can mean the difference between life and death. Who do you think you are that you can bother me while I’m completing —”
Susan stopped listening. She could not bear the thought of abandoning Starling, not when she had screwed up her courage to face the self-proclaimed greatest neurosurgeon in the world. She waited only until Mandar took a breath to say in a voice edged with deadly calm, “You can’t shout at me like this. I had no idea you would answer your phone in the middle of an operation. When you’re ready to have a civil conversation, call me back.” Decisively, she hung up the receiver.
Only then, tears stung Susan’s eyes. She found herself trembling in every part, and that only fueled her anger. She doubted anyone had ever spoken to Sudhish Mandar like that, and she wondered how long it would take for the consequences to reach her, how long before she lost her residency at Manhattan Hasbro.
Worried someone might see her in such a state, Susan wiped the tears from her eyes and sought a distraction. She saw the younger children lining up to use the outside playground, including a heavyset biracial girl who could only be Sharicka Anson. The four-year-old wore a pink dress with embroidered flowers, her hair swept back into a curly ponytail. Through the one-way glass, Susan watched Sharicka reach forward and pinch the boy in front of her.
The boy whirled, snarling, “Cut it out!”
Eyes locked on the television, Sharicka appeared innocently startled by his sudden movement, and the boy slapped the larger girl behind her instead. The other girl screamed bloody murder.
The nurse dashed over, pulling the two children on either side of Sharicka out of line and scolding them. Susan could not hear her words, but her face looked angry. The two youngsters waved their arms and shouted in reply, loudly enough for Susan to catch most of the conversation.
“She pinched me. Really hard.”
“I did not! He hit me for no reason!”
“She did, too.”
“It really hurt,” the girl said, sobbing.
Through it all, Sharicka remained focused on the television, appe
Susan grabbed up her palm-pross and moved to the head of the line. The July sun beamed down upon the rainbow-colored playground, with its plastic slides, ladders, and runways. The sandbox contained the airy, antibacterial sand that had replaced the grit and cat turds that had characterized Susan’s own sandbox experiences growing up. A rideable ditch digger filled most of one corner, with pedals and levers for the children to dig in the sand.
A nurse unlocked the door. Susan went through first. The children followed, some pausing to blink in the direct sunlight and cautiously study their play area of choice. Others charged through the opening, heading pell-mell for the welcoming plastic structure, with its turrets, play bars, and tunnels.
Sharicka funneled through with the rest. Though she had surely played there many times, she scanned the equipment with a seasoned eye. Susan could almost hear the gears spinning in her little head as she marched to the tubes and ladders, climbed a slide, and rode down the plastic surface, bumping loudly against the sides. She seemed almost wooden in her play. She did not raise her arms to touch the wind, did not make “whee” noises, made no attempt to engage her caretakers or peers.
Susan feigned a complete lack of interest in the children, trying to look as if she were focused exclusively on her palm-pross and had only come outside to enjoy the beauty of the day. Sharicka went down the slide a second time, kicking and elbowing the sides but making no verbalizations. When she reached the bottom, she dug the toe of her shoe into a well-worn indentation in the recycled rubber. Soon, she became engrossed in it, scuffing at it with both feet while the boy at the top of the slide waited for her to move out of his way.
It soon became apparent Sharicka had no intention of clearing the path. Susan looked for the nurse and found her pushing a tall, silent girl in a swing, oblivious to the quiet drama unfolding at the slide. Susan did not interfere. She wanted to see what happened next.
“Sharicka, move,” the boy called down to her.
Sharicka continued exploring the worn spot without looking up, though she had certainly heard him.
The boy’s patience waned. “Sharicka, I’m coming down.” With that, he started down the slide.
Sharicka did not budge. Susan saw her roll an eye in the boy’s direction, but she did not step out of his way.
As he reached the bottom, the boy twisted sideways, hitting Sharicka in the side with his hip. Her knee came up as they fell, delivering a blow to his groin. As they tumbled over each other, he collapsed awkwardly to the ground, while she rolled a bit, then exaggerated it into a long, skidding movement that made it look as if she had sustained a heavy hit. She shrieked.
The nurse came running. “What happened?”
The surrounding kids started talking at once, describing the events of the last few moments from various angles. As Susan suspected, certain details became clear to the nurse. Sharicka had gone down the slide first. The boy had gone next and smashed into Sharicka. Therefore, it must be the boy’s fault.
Neither Sharicka nor her victim added much to the discussion. She only smiled, seeming to revel in the lecture the boy got about slide safety and in the tender way he walked, and let the description of the events play out in her favor. She headed to the other end of the play structure and crawled into a tunnel.
For several minutes, play continued without a problem. Then a smiling wisp of a girl entered Sharicka’s tunnel. Susan heard a thump. In an instant, the girl came out the other side, seemingly propelled and crying wildly. She had a red mark beneath her right eye that would surely bruise.
Again, the nurse came running over. “What happened?”
The weeping girl attempted to explain, but Susan could not understand a word of what she said. Sharicka poked her head out of the tunnel. “She tripped climbing over me.”
“Whoops.” The nurse swung the sobbing girl into her arms and carried her to the opposite side of the structure. “We can’t have that.” She turned her focus to consoling the girl, who buried her face in the nurse’s chest.
Worried Sharicka would notice her watching, Susan turned her attention fully on her palm-pross for several moments, actually managing to type some documentation before she dared to look for the girl again. This time, she found Sharicka studying the sandbox. A boy sat alone in the middle, meticulously sculpting something Susan could not yet identify.
Relieved of her burden, the nurse took a seat on a bench on the opposite side of the playground. She rubbed her brow, looking harried and tired. The moment the nurse’s bottom touched the seat, Sharicka ran over and hurled herself into the nurse’s lap. Susan could not hear what she said, but the nurse laughed and hugged her tightly. They sat there for several minutes, talking, laughing, and embracing occasionally. Had Susan happened upon the same scene in a park outside of a psychiatric facility, she would have assumed them a loving mother and daughter team.
More telling for Susan, during the time Sharicka sat safely on the nurse’s lap, the remainder of the children played without interruption. No one cried or shouted in pain. Nothing required refereeing. Not that anyone could mistake these for normal, happy children. They tended to play alone rather than in groups. Like toddlers, each engaged in his or her own activity, often despite the potential playmates less than a foot away doing much the same thing. Some chose one repetitive activity, such as the boy who did nothing but ride one slide from the moment he arrived until playtime ended. But all strife disappeared with Sharicka.
The quiet lulled even Susan, who managed to get some actual work done while Sharicka and the nurse interacted. The sounds of swings creaking, of children chasing one another through plastic tunnels, was so peaceful after the crying and screaming that had preceded it. The warm sun and natural light seemed a welcome change from stuffy corridors and low-energy bulbs.
Then, an anguished cry rent the air. Susan’s gaze went instinctively to the nurse’s lap rather than to the sound. Sharicka was no longer there. Susan then looked toward the sobbing child, the same girl Sharicka had kicked in the tunnel. The nurse confronted the child and a boy nearby. Sharicka appeared to have had no hand in the conflict; yet Susan suspected otherwise. It stirred memories of her M-4 psychiatry rotation. A resident she considered a fabulous teacher had once told her, when trying to find the conduct-disordered child in a family, not to ask which one is involved in the most conflicts but instead to ask which child is always on the scene when conflicts occur. A child with a problem on the conduct spectrum, whether simple ADHD or full-blown Conduct Disorder, can cause chaos merely by entering a room.
While the nurse dealt with the current problem, Susan watched as Sharicka took a seat on the excavator. The boy in the middle of the sandbox had, by now, constructed a lavish series of roads, with hills and valleys, populating them with stone “cars” that ran around dry sand hills while he made motor noises. Susan watched, fascinated, as Sharicka’s digging drew closer and closer to the boy’s art. Soon enough, a new conflict would occur, with the boy screeching about his ruined work and Sharicka proclaiming it all a bizarre accident.
The glass door opened, and a unit clerk poked his head through it. “Dr. Calvin!”
Susan looked in his direction.
“There’s a call for you.”
That surprised Susan. Though accustomed to pages, she rarely received direct calls on the unit. If Stony, Clayton, or one of the nurses needed her, they used the Vox system. Only outsiders or consultants used the phone. Consultants. Abruptly, Susan remembered her interaction with Dr. Mandar, and her heart started pounding. Oh, God. I’m fired. She raced to the door.
The nurse stepped aside to let her through, then handed her the cordless.
Susan tried to sound professional. “This is Dr. Susan Calvin.”
Susan’s heart felt as if it were trying to slug its way out of her chest. When he did not continue, she took a deep breath and began. “I’m wondering if you remember a patient named Starling Woodruff. She’s a thirteen-year-old white female on whom you performed an A-V fistula repair about two years ago.”
Mandar made a wordless noise that spoke volumes. Apparently, he did not recall Starling’s particulars, but he wanted Susan to continue.
“She’s been on the psych unit ever since because of odd behavior they attributed to brain damage from the surgery.”
Susan could almost feel Mandar’s ire rising. “That’s wrong. I have never damaged a brain with a fistula repair.”
Susan remained composed. Starling’s life depended on it. “I agree, Dr. Mandar. That was why I looked for other causes and discovered congestive heart failure.”
There was silence from the other end. Dr. Sudhish Mandar was listening, raptly, to a psychiatry R-1.
“Which is not responding well to medical management. The source of the failure is clearly still present, but Cardiology can’t find it. The only possible source, Dr. Mandar, is …”
“The original fistula,” he filled in for her. “I’ll be down this afternoon.” In an instant, the line went dead.
The moment it did, all the excitement of the moment hit Susan at once. She sank down on the nearest couch, not even noticing she was still in the patient area and that the boy on the next cushion was Diesel Moore. She felt dizzy, faint, and her hand trembled as she clutched the phone in white-knuckled fingers.
Diesel stuck his moon face into hers. “Dr. Calvin? Are you all right?”
“I’m fine,” she assured him, though her voice sounded far away.
Kendall seized Susan’s arm and pulled her to her feet. Looping an arm around her back, he guided her toward the office. “Did I hear you say ‘Dr. Mandar’?”
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