Danger is a hazard of our job. Most of the time we save people, but a misplaced wire, a needle stuck too deep, a valve deployed in just the wrong spot—they can be life altering or ending for our patients. But we can usually gauge the risk and offer our patients guidance for their expectations. Things happen, and we don’t have time to dwell on them, because the next patient will be on the table in fifteen minutes.
But there are “never events,” mistakes that even our least experienced trainees cannot afford to make. This was clearly one of them.
“Brandon,” I say quietly. “You’re not well. You need to get help. Go see a doctor, figure out what is going on.”
Brandon’s right eye widens more than his left.
“I know,” he says. “I know, I know, I know, but. I can’t. I can’t—”
I step closer, reach for him.
“What do you mean, you can’t?” I ask slowly. “Why can’t you?”
The next half second passes in slow motion. It starts with his shoulders, their steady slouch, and the rest of his body follows, chin dropping into chest, lips dropping into chin. His eyes are the last to go, rolling back in a tight swivel.
I move before I can think. Brandon’s weight is full and dead and sends me crumpling to the floor. I land hard, but I barely feel the impact; my fingers scrabble on his carotid for a pulse before my brain can fully process what is happening.
And then it does, and I begin to scream.
“Help!” Under my fingertips, I feel the steady thrum of his pulse: slow, thready, but there. I roll Brandon onto his back and the horror overcomes me. It’s like I’m looking at his corpse.
Pamela is the first around the corner.
“What’s going on, Sean— Holy shit.”
I don’t have time to wonder whether she, too, is seeing what I see now—that Brandon has probably been far gone for a while and that we just didn’t notice.
“Get the crash cart and have someone call a code,” I instruct, and Pamela, a consummate professional, puts aside her horror to comply.
Twenty-One
By the afternoon, Brandon has been admitted to the hospital. The MRI of his brain shows a tumor. It’s on the left side, the part that gets exposed to the most radiation, and is infiltrating his frontal lobe. It could explain his recent personality changes, the neurologist tells Winona over the phone.
Brandon Pendersen has fucking brain cancer, and I—we all—assumed he had just become an incompetent jerk. We’d watched him decay before our eyes and said nothing. Now there’s another patient in a different ICU fighting for his life because none of his colleagues had the foresight to investigate whether his erratic behavior was actually pathological.
“Left-sided brain cancer,” Brandon mutters when I visit him after my cases. He looks oddly at peace. When he smiles the right side goes up higher than the left. I’d thought he was sneering this whole time, but it was actually a neurological deficit. “What am I? A textbook?”
I laugh. All our radiation training modules have emphasized the same thing—that proceduralists who use fluoroscopy are more prone to this particular kind of disease because our left sides get the brunt of radiation exposure. We wear lead-lined caps and goggles tominimize the damage, but we’re still significantly more likely to get it. But Brandon is young, having just scratched forty, and shouldn’t yet have been at high risk.
“I should bring our fellows down here,” I joke. “Show them the scans. Strike some fear in their hearts.”
“Especially Paul. Might get him to wear his thyroid shield,” Brandon quips. Then he closes his eyes. “Has anyone been able to get Leila?”
I swallow.
“No,” I say gently. Not for lack of trying. Between me, the neurologist, and Brandon himself, we’ve probably called and texted Leila twenty times. Her phone goes straight to voicemail. When I call her coworker to ask after her, he says that she’s doing three mitral clip procedures in a hospital forty miles away today and might be tough to reach.
It’s an odd excuse. We’ve worked with Leila in the lab; we know she can access her phone. Winona, who has a full panel of clinic patients today, has managed to answer our calls, arrange alternate pickup plans for Sophie, and is driving in as we speak.
Brandon looks, for the first time, like he’s in pain.
“You think I’m pathetic,” he says quietly.
I freeze.
“I don’t know what you mean,” I say.
Brandon’s grin is wry.